Guest guest Posted July 18, 2008 Report Share Posted July 18, 2008 The special price...and to the doc with the pedestrian hit and run. I had one similar last year and we billed and were paid by her PIP carrier. J. Holzapfel, DCAlbany, Oregon-- Franchesca Harper <dr-harper@...> wrote: Hi can someone answer me about how to bill insurance when you ran a "special" that allows patients to come in for a discounted exam? Do you not charge the insurance for the first day exam or do you charge them only the special price that you are running for the month?ThanksRespectfully, Dr. Franchesca HarperFunctional Pain Solutions6956 SW Hampton StTigard, OR 97223p. 503-443-6100f. 503-443-1280 Use video conversation to talk face-to-face with Windows Live Messenger. Get started. ____________________________________________________________ Click for a credit repair consultation, raise your FICO score. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2008 Report Share Posted September 15, 2008 Hi all, This may be a silly question but I just wanted to make sure. Right now I see a patient for attended stim, trigger point work and therepeutic exercises. She comes in far more often for that than for adjustments at this point in her care. Her insurance only approves 12 chiropractic visits a year. She has 60 approved PT visits. Since the stim and exercises fall under physical therapy can they be billed that way or is a chiropractor doing that still considered billing for chiropractic services.? We had to take PT boards to be able to do this in the state of OR, so do we bill differently when no adjustment is performed? Obviously the codes change but will the insurance company look at it any differently? My patient told me and one of the people at the billing company told me if I am just doing PT and not adjusting it could be billed as PT. Thoughts? Suggestions? This is with BCBS with an intermediary of amica so they put the cap on these things not BCBS. Respectfully, Dr. Franchesca HarperFunctional Pain Solutions6956 SW Hampton StTigard, OR 97223p. 503-443-6100f. 503-443-1280 Want to do more with Windows Live? Learn “10 hidden secrets” from . Learn Now Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2008 Report Share Posted September 15, 2008 Francesca, You better check with BCBS to see if her PT benefits can be provided by a chiropractor in the first place....we have had a number of cases this past year where BCBS has declared it is their policy that PT benefits can ONLY be provided by a licensed PT regardless that PT is in your chiropractic scope of practice. This has been challenged legally by one of our patients, and they lost the appeal process. So be forewarned on that front. It is a clear case of discrimination and deserves a class action law suit, but until a patient or two or three steps forward to file one, BCBS will continue to get away with this. Best regards, Jeff K. Tunick D.C. Lordex Spine Institute at Lincoln Health Center 10500 SW Greenburg Rd., Suite 200 Portland, OR 97223 503-684-9698 Office 503-213-9698 Fax www.lordexpdx.com > > Hi all, > > This may be a silly question but I just wanted to make sure. Right now > I see a patient for attended stim, trigger point work and therepeutic > exercises. She comes in far more often for that than for adjustments at > this point in her care. Her insurance only approves 12 chiropractic > visits a year. She has 60 approved PT visits. Since the stim and > exercises fall under physical therapy can they be billed that way or is > a chiropractor doing that still considered billing for chiropractic > services.? We had to take PT boards to be able to do this in the state > of OR, so do we bill differently when no adjustment is performed? > Obviously the codes change but will the insurance company look at it > any differently? My patient told me and one of the people at the > billing company told me if I am just doing PT and not adjusting it > could be billed as PT. Thoughts? Suggestions? This is with BCBS with an > intermediary of amica so they put the cap on these things not BCBS. > Respectfully, Dr. Franchesca HarperFunctional Pain Solutions6956 SW > Hampton StTigard, OR 97223p. 503-443-6100f. 503-443-1280 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2008 Report Share Posted September 15, 2008 Sharron, It's a definite problem....on one of my cases, we were able to avoid a scheduled back surgery, and when I spoke to BCBS, they insisted the services had to be provided by a licensed PT and thanked me for helping her! When I asked them how they could make an interpretation that was so clearly discriminatory, the answer was, " Because we can " .....great ethics don't you think? It's clearly a class action suit waiting to happen, as I'm sure I'm not the only DC with this experience. I probably see it more often as all my billing codes for decompression are in the PT arena. The patient's are the real losers in this situation, because they have to go out of pocket to get the care that is rightfully theirs under contract. The BCBS documents describing PT services do NOT say they must be provided by a licensed PT ONLY..... Maybe this discussion thread will lead to some patients getting angry enough that a class action suit will be filed. I've spoken about the issue with a number of attorneys on our list serve and they all agreed that this is discrimination that needs to be challenged. Best regards, Jeff K. Tunick D.C. Lordex Spine Institute at Lincoln Health Center 10500 SW Greenburg Rd., Suite 200 Portland, OR 97223 503-684-9698 Office 503-213-9698 Fax www.lordexpdx.com > How is it that PT's get paid by insurance for adjusting ? If we can't > get paid for scope of practice PT how can they get paid for what I would > consider out of their scope adjusting ? What about starting with a > patient complaint to the Dept. of Insurance ? > > > > s. fuchs dc > > > > ________________________________ > > From: [mailto: ] On > Behalf Of K. Tunick D.C. > Sent: Monday, September 15, 2008 1:49 PM > Franchesca Harper > Cc: > Subject: Re: Billing Question > > > > Francesca, > > You better check with BCBS to see if her PT benefits can be provided by > a > chiropractor in the first place....we have had a number of cases this > past > year where BCBS has declared it is their policy that PT benefits can > ONLY > be provided by a licensed PT regardless that PT is in your chiropractic > scope of practice. This has been challenged legally by one of our > patients, and they lost the appeal process. So be forewarned on that > front. > > It is a clear case of discrimination and deserves a class action law > suit, > but until a patient or two or three steps forward to file one, BCBS will > continue to get away with this. > > Best regards, > > Jeff > > K. Tunick D.C. > Lordex Spine Institute at Lincoln Health Center > 10500 SW Greenburg Rd., Suite 200 > Portland, OR 97223 > 503-684-9698 Office > 503-213-9698 Fax > www.lordexpdx.com >> >> Hi all, >> >> This may be a silly question but I just wanted to make sure. Right now >> I see a patient for attended stim, trigger point work and therepeutic >> exercises. She comes in far more often for that than for adjustments > at >> this point in her care. Her insurance only approves 12 chiropractic >> visits a year. She has 60 approved PT visits. Since the stim and >> exercises fall under physical therapy can they be billed that way or > is >> a chiropractor doing that still considered billing for chiropractic >> services.? We had to take PT boards to be able to do this in the state >> of OR, so do we bill differently when no adjustment is performed? >> Obviously the codes change but will the insurance company look at it >> any differently? My patient told me and one of the people at the >> billing company told me if I am just doing PT and not adjusting it >> could be billed as PT. Thoughts? Suggestions? This is with BCBS with > an >> intermediary of amica so they put the cap on these things not BCBS. >> Respectfully, Dr. Franchesca HarperFunctional Pain Solutions6956 SW >> Hampton StTigard, OR 97223p. 503-443-6100f. 503-443-1280 >> >> >> >> > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2008 Report Share Posted September 15, 2008 My thinking is first to have many patients file complaints with the Dept. of Insurance ( not the correct name) and then there will be documentation with some one other than the doctor's office to obtain information from. Similar to documenting worker's being steered, unlawfully, to certain clinics. s.fuchs dc Re: Billing Question > > > > Francesca, > > You better check with BCBS to see if her PT benefits can be provided by > a > chiropractor in the first place....we have had a number of cases this > past > year where BCBS has declared it is their policy that PT benefits can > ONLY > be provided by a licensed PT regardless that PT is in your chiropractic > scope of practice. This has been challenged legally by one of our > patients, and they lost the appeal process. So be forewarned on that > front. > > It is a clear case of discrimination and deserves a class action law > suit, > but until a patient or two or three steps forward to file one, BCBS will > continue to get away with this. > > Best regards, > > Jeff > > K. Tunick D.C. > Lordex Spine Institute at Lincoln Health Center > 10500 SW Greenburg Rd., Suite 200 > Portland, OR 97223 > 503-684-9698 Office > 503-213-9698 Fax > www.lordexpdx.com >> >> Hi all, >> >> This may be a silly question but I just wanted to make sure. Right now >> I see a patient for attended stim, trigger point work and therepeutic >> exercises. She comes in far more often for that than for adjustments > at >> this point in her care. Her insurance only approves 12 chiropractic >> visits a year. She has 60 approved PT visits. Since the stim and >> exercises fall under physical therapy can they be billed that way or > is >> a chiropractor doing that still considered billing for chiropractic >> services.? We had to take PT boards to be able to do this in the state >> of OR, so do we bill differently when no adjustment is performed? >> Obviously the codes change but will the insurance company look at it >> any differently? My patient told me and one of the people at the >> billing company told me if I am just doing PT and not adjusting it >> could be billed as PT. Thoughts? Suggestions? This is with BCBS with > an >> intermediary of amica so they put the cap on these things not BCBS. >> Respectfully, Dr. Franchesca HarperFunctional Pain Solutions6956 SW >> Hampton StTigard, OR 97223p. 503-443-6100f. 503-443-1280 >> >> >> >> > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2008 Report Share Posted September 16, 2008 Theres no silly questions here My understanding is that you are a chiropractor and so in the eyes of the insurer the patient is experiencing a chiropractic visit no matter what services you provided. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx.com Billing Question Hi all, This may be a silly question but I just wanted to make sure. Right now I see a patient for attended stim, trigger point work and therepeutic exercises. She comes in far more often for that than for adjustments at this point in her care. Her insurance only approves 12 chiropractic visits a year. She has 60 approved PT visits. Since the stim and exercises fall under physical therapy can they be billed that way or is a chiropractor doing that still considered billing for chiropractic services.? We had to take PT boards to be able to do this in the state of OR, so do we bill differently when no adjustment is performed? Obviously the codes change but will the insurance company look at it any differently? My patient told me and one of the people at the billing company told me if I am just doing PT and not adjusting it could be billed as PT. Thoughts? Suggestions? This is with BCBS with an intermediary of amica so they put the cap on these things not BCBS. Respectfully, Dr. Franchesca HarperFunctional Pain Solutions6956 SW Hampton StTigard, OR 97223p. 503-443-6100f. 503-443-1280 Want to do more with Windows Live? Learn “10 hidden secrets” from . Learn Now Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2008 Report Share Posted September 16, 2008 We have had a different experience with BCBS with regards to this issue. If no chiropractic adjustment is performed, they have applied the services to the PT benefit not the chiro benefit. This may be different depending on the state from which the plan was written. McCabe, DC > > Theres no silly questions here > > My understanding is that you are a chiropractor and so in the eyes of the insurer the patient is experiencing a chiropractic visit no matter what services you provided. > > > > ph Medlin D.C. > Spine Tree Chiropractic > 1607 NE Alberta St. > PDX, OR 97211 > www.spinetreepdx.com > Billing Question > > > Hi all, > > This may be a silly question but I just wanted to make sure. Right now I see a patient for attended stim, trigger point work and therepeutic exercises. She comes in far more often for that than for adjustments at this point in her care. Her insurance only approves 12 chiropractic visits a year. She has 60 approved PT visits. Since the stim and exercises fall under physical therapy can they be billed that way or is a chiropractor doing that still considered billing for chiropractic services.? We had to take PT boards to be able to do this in the state of OR, so do we bill differently when no adjustment is performed? Obviously the codes change but will the insurance company look at it any differently? My patient told me and one of the people at the billing company told me if I am just doing PT and not adjusting it could be billed as PT. Thoughts? Suggestions? This is with BCBS with an intermediary of amica so they put the cap on these things not BCBS. > > Respectfully, > > > Dr. Franchesca Harper > Functional Pain Solutions > 6956 SW Hampton St > Tigard, OR 97223 > p. 503-443-6100 > f. 503-443-1280 > > > > > > > > -------------------------------------------------------------------- ---------- > Want to do more with Windows Live? Learn " 10 hidden secrets " from . Learn Now > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2008 Report Share Posted September 17, 2008 You're right. I was on the phone with them yesterday and asked this question while i was there. They said it should be a PT visit if thats what was provided. That being said, there are many out of state plans and variations that could apply it differently, re-imburse you differently etc. Perhaps in this particular case it is an Amica thing. Franchesca, check with your BCBS provider representative to nail down an answer. If you get one, please update us. Good times. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx.com Billing Question> > > Hi all,> > This may be a silly question but I just wanted to make sure. Right now I see a patient for attended stim, trigger point work and therepeutic exercises. She comes in far more often for that than for adjustments at this point in her care. Her insurance only approves 12 chiropractic visits a year. She has 60 approved PT visits. Since the stim and exercises fall under physical therapy can they be billed that way or is a chiropractor doing that still considered billing for chiropractic services.? We had to take PT boards to be able to do this in the state of OR, so do we bill differently when no adjustment is performed? Obviously the codes change but will the insurance company look at it any differently? My patient told me and one of the people at the billing company told me if I am just doing PT and not adjusting it could be billed as PT. Thoughts? Suggestions? This is with BCBS with an intermediary of amica so they put the cap on these things not BCBS. > > Respectfully,> > > Dr. Franchesca Harper> Functional Pain Solutions> 6956 SW Hampton St> Tigard, OR 97223> p. 503-443-6100> f. 503-443-1280> > > > > > > > --------------------------------------------------------------------> Want to do more with Windows Live? Learn "10 hidden secrets" from . Learn Now> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 25, 2008 Report Share Posted September 25, 2008 All, This seems illegal and completely - wrong. I can see this rule being enforced if all the treatments are generated at the same office and one of the DCs in the same clinic is negligent at records release. But not entirely different offices. Just out of curiosity, do you know if it's even different types of providers? Not that it should matter. You're not responsible for other providers outside of your clinic premises. Or would Aetna even tell you? I'd call the ins commissioner's office and ask if this is legal. Also, I'd ask for the billing specialist who told you this to please put this in writing, signing their name, employee ID number and date on official letterhead. Tell them that you just need it formally documented so you understand future procedures in order to ensure ease of compliance. Tell them they can fax it to your office immediately for the patient record, because the patient will want to understand why they are required to pay out of pocket for a service they thought was covered. Tell them it will help you more easily explain to the patient- without further confusion- why their portion of the bill is so much higher than either of you thought it would be. Let them know that you're happy to reimburse the patient once the 'other' unrelated offices; with no connection to yours; complete their communication with Aetna. Assure Aetna that when it completes it's payment to you on behalf of their member, you will reimburse the patient. If they refuse to give you a written document, let them know that it's not a problem as the conversation is already recorded or simply ask them to re-state the 'policy' again while you 'RECORD' their policy statement. Telephone recording devices are inexpensive at radio shack and simple to hook up. Correct me if I'm wrong, but at the beginning of each insurance encounter now, there's a canned message that states that the call may be recorded for 'quality assurance'. That satisfies the rule in Oregon that at least ONE party has been notified of a potential recorded conversation. Minga Guerrero DC In a message dated 9/25/2008 12:05:26 P.M. Pacific Daylight Time, glendaculbertson@... writes: I contacted Aetna yesterday because they had been resuming and then stoping payments on a patient of mine. A few months ago, I got a letter from them saying they needed my intake and all chart notes. I always send them my chart notes, so I knew they already had those, but sent the intake as requested. They resumed one payment and then I got the same statement for claim denial on following payments asking once again for intake and chart notes...well, I finally called them yesterday, to see what was up...they could not give me a straight answer yesterday and said they would call me back. This morning they called me back and said that they could not resume payments until they received treatment notes from the other practicioners that were treating her. Has anyone ever heard of this? This did not seem right to me... My payment should not be dependent upon wether or not another practicioner submits their information...they might NEVER submit their information and I'd never be paid! This is a straight forward case, nothing unusual. She is not workman's comp, auto, etc...just a regular out-of-network health insurance based patient. Is this legal? Glenda Culbertson D.C. (503)475-4370 Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 25, 2008 Report Share Posted September 25, 2008 Isn't it odd that they didn't just tell her they have NO REFERRAL from the patient's PCP? I wonder if that's all it was? sigh. In which case the patient has to pay and the insurance can reimburse them later. I'd still keep the recorder on hand for those really pesky convoluted explanations. Minga In a message dated 9/25/2008 1:12:09 P.M. Pacific Daylight Time, dcdocbrian@... writes: aetna policies frequently require medical referral. A hard copy is not required up front but notation of referral must be in the referring physicians notes. Seitz, DC Tuality Physicians 730-D SE Oak St Hillsboro, OR 97123 (503)640-3724 From: glendaculbertson Date: Thu, 25 Sep 2008 12:04:28 -0700Subject: billing question I contacted Aetna yesterday because they had been resuming and then stoping payments on a patient of mine. A few months ago, I got a letter from them saying they needed my intake and all chart notes. I always send them my chart notes, so I knew they already had those, but sent the intake as requested. They resumed one payment and then I got the same statement for claim denial on following payments asking once again for intake and chart notes...well, I finally called them yesterday, to see what was up...they could not give me a straight answer yesterday and said they would call me back. This morning they called me back and said that they could not resume payments until they received treatment notes from the other practicioners that were treating her. Has anyone ever heard of this? This did not seem right to me... My payment should not be dependent upon wether or not another practicioner submits their information...they might NEVER submit their information and I'd never be paid! This is a straight forward case, nothing unusual. She is not workman's comp, auto, etc...just a regular out-of-network health insurance based patient. Is this legal? Glenda Culbertson D.C. (503)475-4370 Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 25, 2008 Report Share Posted September 25, 2008 aetna policies frequently require medical referral. A hard copy is not required up front but notation of referral must be in the referring physicians notes. Seitz, DC Tuality Physicians 730-D SE Oak St Hillsboro, OR 97123 (503)640-3724 From: glendaculbertson@...Date: Thu, 25 Sep 2008 12:04:28 -0700Subject: billing question I contacted Aetna yesterday because they had been resuming and then stoping payments on a patient of mine. A few months ago, I got a letter from them saying they needed my intake and all chart notes. I always send them my chart notes, so I knew they already had those, but sent the intake as requested. They resumed one payment and then I got the same statement for claim denial on following payments asking once again for intake and chart notes...well, I finally called them yesterday, to see what was up...they could not give me a straight answer yesterday and said they would call me back. This morning they called me back and said that they could not resume payments until they received treatment notes from the other practicioners that were treating her. Has anyone ever heard of this? This did not seem right to me... My payment should not be dependent upon wether or not another practicioner submits their information...they might NEVER submit their information and I'd never be paid! This is a straight forward case, nothing unusual. She is not workman's comp, auto, etc...just a regular out-of-network health insurance based patient. Is this legal? Glenda Culbertson D.C. (503)475-4370 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 25, 2008 Report Share Posted September 25, 2008 Before taking major steps, check with the patient. Has the patient treated with any other provider for the same or similar condition? If Aetna is receiving bills for similar services on the same day (or adjacent days), there could be concern about the appropriateness of treatment. You may be managing the care in one manner and the patient is not reporting anything back to you about other care. The insurance company may have a legitimate concern if there is a duplication of service. In this case, review of the other providers records may help clarify the matter. Tom Freedland, DC Posted by: "glenda culbertson" glendaculbertson@... glendaculbertson Thu Sep 25, 2008 12:04 pm (PDT) I contacted Aetna yesterday because they had been resuming and then stoping payments on a patient of mine. A few months ago, I got a letter from them saying they needed my intake and all chart notes. I always send them my chart notes, so I knew they already had those, but sent the intake as requested. They resumed one payment and then I got the same statement for claim denial on following payments asking once again for intake and chart notes...well, I finally called them yesterday, to see what was up...they could not give me a straight answer yesterday and said they would call me back. This morning they called me back and said that they could not resume payments until they received treatment notes from the other practicioners that were treating her. Has anyone ever heard of this? This did not seem right to me... My payment should not be dependent upon wether or not another practicioner submits their information...they might NEVER submit theirinformation and I'd never be paid! This is a straight forward case, nothing unusual. She is not workman's comp, auto, etc...just a regular out-of-network health insurance based patient. Is this legal? Glenda Culbertson D.C.(503)475-4370 Posted by: "AboWoman@..." AboWoman@... Thu Sep 25, 2008 1:07 pm (PDT) All, This seems illegal and completely - wrong. I can see this rule being enforced if all the treatments are generated at the same office and one of the DCs in the same clinic is negligent at records release. But not entirely different offices. Just out of curiosity, do you know if it's even different types of providers? Not that it should matter. You're not responsible for other providers outside of your clinic premises. Or would Aetna even tell you? I'd call the ins commissioner's office and ask if this is legal. Also, I'd ask for the billing specialist who told you this to please put this in writing, signing their name, employee ID number and date on official letterhead. Tell them that you just need it formally documented so you understand future procedures in order to ensure ease of compliance. Tell them they can fax it to your office immediately for the patient record, because the patient will want to understand why they are required to pay out of pocket for a service they thought was covered. Tell them it will help you more easily explain to the patient- without further confusion- why their portion of the bill is so much higher than either of you thought it would be. Let them know that you're happy to reimburse the patient once the 'other' unrelated offices; with no connection to yours; complete their communication with Aetna. Assure Aetna that when it completes it's payment to you on behalf of their member, you will reimburse the patient. If they refuse to give you a written document, let them know that it's not a problem as the conversation is already recorded or simply ask them to re-state the 'policy' again while you 'RECORD' their policy statement. Telephone recording devices are inexpensive at radio shack and simple to hook up. Correct me if I'm wrong, but at the beginning of each insurance encounter now, there's a canned message that states that the call may be recorded for 'quality assurance'. That satisfies the rule in Oregon that at least ONE party has been notified of a potential recorded conversation. Minga Guerrero DCLooking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators. Quote Link to comment Share on other sites More sharing options...
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