+ Is there a place where I can find out what procedures and laboratory tests are covered by private insurers?
- Is there a place where I can find out what procedures and laboratory tests are covered by private insurers?
Private insurance carriers sometimes maintain policies similar to Medicare policies on their Web sites. However, unlike Medicare, private plans are not required to keep their policies available through their Web sites, so phone calls to provider relations and payment representatives are often required. Additionally, private insurers categorize these policies under different names such as Medical Policies, Medical Coverage Rules, etc.
Private insurers communicate many of their medical policy changes via newsletter so it is imperative that your practice keeps current on this literature. They will also refer you to a certain newsletter if you call to ask about a policy so it is also important to keep these in order and accessible.
+ If an Insurance Company pays for services rendered by Doctors Office, yet does not post and cash check until after patient has moved on to a new plan, is patient still responsible for original payment?
- If an Insurance Company pays for services rendered by Doctors Office, yet does not post and cash check until after patient has moved on to a new plan, is patient still responsible for original payment?
If a patient signs forms in a doctor's office saying that they accept responsibility for any expenses not covered by their health plan, the patient may be responsible unless the doctor's office forces the patient's old carrier to make good on a claim that occurred prior to the patient's transition of policies.
+ How long does a company have to pay a medical claim?
- How long does a company have to pay a medical claim?
The insurance company has 45 days to either pay or deny a claim once proof of loss has been received, unless additional information is requested.
+ Can you bill the patient for cancellations?
- Can you bill the patient for cancellations?
Yes, the physician can charge for this as long as all patients are subject to the cancellation fee. Also the notice should be displayed prominently in the office where patients can see it.
+ Do private health insurance companies cover and reimburse for ENBREL?
- Do private health insurance companies cover and reimburse for ENBREL?
Many private plans cover and reimburse for ENBREL. However, some managed care organizations may require prior authorization for patients to obtain ENBREL.
+ How do I know if my practice is collecting payment from insurance companies in a timely and successful manner?
- How do I know if my practice is collecting payment from insurance companies in a timely and successful manner?
All practices should be using a benchmark to measure their collection rates. Benchmarks are used to compare your collection rate with other practices to ensure you are meeting the average or are collecting at a greater rate than other practices are.
+ Which insurance companies have been found to be the best and the worst for billing issues?
- Which insurance companies have been found to be the best and the worst for billing issues?
This is a relative question depending on how you define "best" and "worst." Physicians Practice released its 2009 Payer Performance Survey, which found Humana, Aetna and Cigna first, second, and third respectively in overall payer performance. This was based on the amount of time it took for payers to expect payment, claim denial rates, and compliance with national coding standards. However, based on the region you practice in or your patient population, this might not be true. It is important to ensure that no matter which insurance company you are working with, that your denial rate stays below 10 percent and that at least 60 percent of your claims are paid within 30 days.
+ Why do I get so many denials from insurance companies?
- Why do I get so many denials from insurance companies?
Based on the Health Insurance Association of America's survey in 2003, the top reason insurance companies deny a claim is because of duplication (48 percent). The other reasons in order of popularity are: termination of coverage (22 percent), non-covered benefit (20 percent), other (7 percent) and eligibility (3 percent). It is important to ensure you don't submit duplicate claims and confirm all of your patients' coverage BEFORE their visits.
