Insurance/HIPPA

[Guest guest]

i figured its easier just to have patients sign the sheet than to try to

figure out whether or not HIPPA applies to you if you don't take insurance.

its no big deal just to have them sign, and then you've CYA.

 

kb

 

 

On 1/24/07, Angela Pfaffenberger <angela.pf wrote:

>

> My understanding is that if you are cash and carry only, co-pays don't

> apply. But say, a client asks me to send to the insurance. Even if I am not

> in-network, I need to collect the co-pay. Such insurances become more rare,

> but they do exist. I need to collect the copay because I am a licensed

> provider in Colorado and there is a law in Colorado that says providers are

> not allowed to interfere with insurance contracts and agreements. It does

> not apply to Ac alone, all providers are included.

>

> I think this is new in the last few years; before insurances tried to

> regulate provider behavior, but they had no real teeth, now they succeeded

> in creating state laws that support them.

>

> I don't know how other states regulate this issue, Colorado is very

> Republican, big-business oriented.

>

> My understanding of HIPPA compliance is that it depends if you ever

> electronically communicate at all, if yes, you need to become compliant even

> if you do not file for insurance. If there is no electronic communication

> ever, you do not need to become compliant. A lawyer with a health care

> license explained that to me; however I am not 100% sure about faxes, but it

> does apply to internet communications, including all emails. For me HIPPA

> compliance mainly means giving clients the disclosure sheet and obtaining

> the signature.

> Angela Pf

>

> .

> -

> mike Bowser

> To:

Chinese Traditional Medicine <Chinese Traditional Medicine%40yaho\

ogroups.com>

> Wednesday, January 24, 2007 12:56 PM

> RE: Insurance

>

> Angela,

>

> I find this odd as it implies that everyone is now a network provider,

> kind of like forced labor or fixed pricing. That would also imply that all

> your state LAc are now HIPAA compliant (patient can send in a bill but you

> must collect the copay). I know in the past that many LAc have tried to opt

> out by having a cash-only practice. Has you licensing board made any

> determinations on this?Mike W. Bowser, L Ac

>

> To:

Chinese Medicine<Chinese Medicine%40\

From>:

> angela.pf <angela.pf%40comcast.netDate>: Wed, 24 Jan 2007

> 09:49:53 -0700Re: Insurance

>

> My understanding is that any time you bill an insurance you have to

> collect the copay. Not doing so is called " interfering with the insurance

> agreement " and it's illegal. I don't think it matters if you are in-network

> or not, it's a state law. Angela Pf.- mike

> Bowser To:

Chinese Traditional Medicine <Chinese Traditional Medicine%40yaho\

ogroups.com>Wednesday, January 24, 2007 9:37 AMRE: TCM -

> InsuranceAngela,How does the CO regulations deal with out-of-network

> providers (not a member of an HMO) as far as collection of co-pays? Mike W.

> Bowser, L AcTo:

Chinese Medicine<Chinese Medicine%40\

From>:

> angela.pf <angela.pf%40comcast.netDate>: Wed, 24 Jan 2007

> 08:32:00 -0700Re: Insuranceyes, regulation of fees varies by

> state. I know that Colorado specifically forbids NOT collecting copays, it

> also states that only small discounts for cash payments are allowed, Oregon

> also explicitly states that your charges have to be consistent, meaning you

> cannot have a higher payscale for insurance.California obviously allows

> any discount as long as the client is not insured. I guess it all comes down

> to how influential the insurance industry is and how much they are able to

> influence the legislature...I am not sure I have ever heard of an individual

> practitioner getting caught and punished, but I know that some of my clients

> have sent in bills to their insurance that I only later found out about. I

> also know that an insurance company went after a subsection of the local

> hospital for giving free or strongly reduced counseling to clients in need

> and the hospital had to pay punitive fees later.Angela Pf, Colorado.-----

> Original Message -----

anne.crowley<anne.crowley%40comcast.net>To:

>

Chinese Medicine <Chinese Medicine%40yaho\

ogroups.com>Tuesday, January 23, 2007 5:26 PMRe: Business

MgmtI

> would like to hear more on this. Barabara thinks it is okay and Avery thinks

> it is illegal. I think chiros do the range of fees often.I always thought

> you had to charge everyone the same and could give someone a discount based

> on need. Is this different for different states?The insurance game I was

> talking about was charging insurance 200 per treatment and between the copay

> and the reimbursement practitioner got 95, was a member of the plan and was

> paid pretty well based on this. I know they don't charge everyone that -

> quite a lot less.Anne-------------- Original message

> ---------------------- " Dr. Avery Jenkins "

<docaltmed<docaltmed%40sbcglobal.net>>>

> That is quite illegal.> > Avery> > > > > Anne,> >> > I couldn't help but

> respond to this as it is often misunderstood and> > misapplied. It's not an

> insurance game to charge " more " for insurance> > billings than for those who

> are paying " out-of-pocket " . Your real > > price is> > what is charged to

> insurance and to anyone else who is not going to give > > you> > payment

> that day of treatment. For example, let's just say for a return> > visit

> your price is $90. For the patient who pays the same day as > > service,> >

> a (legal) " payment same day of service discount " is applied. The > > amount

> of> > that discount is up to you, but I wouldn't recommend anything over

> 20%. > > So,> > that would make the cash paying patient charge of $72. Your

> time and> > energy and sometimes months of waiting (and calling repeatedly)

> is > > accounted> > for in your real (e.g., insurance) rate. Technically,

> a practitioner> > should offer this same discount to any insurance company

> that can pay > > their> > bill within 7 days. A note can be sent with

> billings letting them know > > of> > the savings that can reap by quick

> payment. There is nothing illegal or> > unethical about this practice. Many

> MD's and dentists, in my experience,> > offer this type of discount to

> patients as a thank you for eliminating a> > bunch of waiting and work.> > >

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