Skyline Medical Billing Management discusses balance billing for your Prescott medical practice

As a medical provider, a significant part of your business is medical billing and working with insurance companies. This is not typically considered glamorous or fun work to do, but it is necessary. One drawback of this payment model and system is that you can end up footing the remainder of a bill if the client meets their deductible and the insurance company meets their requirements. Skyline Medical Billing Management discusses balance billing for your Prescott medical practice.

Is it legal?
It may be tempting to bill your client for the remainder of a bill, but in some cases, this is illegal or could open you up to legal action for breach of contract with an insurance provider. The legality depends on state law and your agreement with insurance companies. A few situations where it is usually illegal to balance bill are when you accept Medicare, Medicaid, or you have a contract with an insurance company and bill more than the contract allows.

Under what circumstances?
However, there are circumstances where balance billing is perfectly legal. These situations typically involve out-of-network clients and procedures that are not covered by the insurance provider. If you are doing procedures that are not medically necessary, you may consider alternative billing methods such as receiving a portion of the bill prior to a procedure.

Out-of-network 

If your practice is out-of-network with the insurance company/patient’s plan, you can balance bill the patient for the FULL charged amount - not what the insurance company allows.

• Example: The doctor’s office bills a patient’s insurance $150.00 for an office visit (99204). The EOB comes in showing the insurance company allowed $102.50 toward the patient’s out-of-network deductible. Because the doctor is not contracted with the insurance company or the patient’s plan - in other words, not bound by in-network rate agreements - the doctor can balance bill the patient for the full $150.00.

Do your research
Before you decide to balance bill a client, be sure that you are up-to-date on state law and are familiar with your insurance provider contracts. Have your billing practices reviewed by an experienced attorney and medical billing expert to ensure your medical practice remains compliant. Additionally, consider that many clients will be unable to pay the remainder of their bill, and negotiating with a client may result in a more favorable outcome for your you.

If you have questions regarding balance billing or general medical billing for your Prescott practice, call Skyline Medical Billing Management at 928-227-1167 or visit us online at https://www.skylinembm.com.

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Skyline Medical Billing Management discusses the process of medical claims submission for your Prescott practice

A key to prompt insurance reimbursements is not underestimating what is necessary to move the claim from your office through the various steps until it returns to you in a timely manner and in the form of an acceptable payment. It's a mistake to regard medical billing as a clerical function or part-time job. Cash flow will either make or break your practice. Skyline Medical Billing Management recommends outsourcing this critically important facet of your Prescott medical practice to the experts.

In-House Billing
Most medical practices are probably not aware that doing your own in-house billing costs you time and money in greater delays and more errors. If you do your own billing, the claims are sent by your billing staff to Medicare or the insurance carrier for reimbursement. The entire reimbursement process can take as much as six weeks if your office is filing your own medical claims.

Outsourcing Billing
If you outsource your billing, you'll find the reimbursement process can be shortened to as little as two weeks. A professional medical billing business has systems in place to simplify the process while ensuring the highest degree of patient confidentiality. Instead of sending your claims to an insurance carrier or government provider, you transmit all of your claims to your medical billing resource. Once there, your billing company will enter and double check your submitted claims for errors and batch transmit them directly to the carriers or utilize the services of a clearinghouse.

Clearinghouses
A clearinghouse will edit and convert the claim information into a standard format and forward it onto the carrier for processing. Upon receipt, the carrier typically transmits a confirmation allowing the claim to be tracked. Instead of six weeks, your office can expect reimbursement, along with an EOB, in about two weeks when using electronic claim filing.

The use of a clearinghouse means adding one more layer of scrutiny to catch the occasional coding error, providing your office with increased efficiency and expedited revenue recovery, as you experience less than 1% of your claims rejected due to coding errors. A good clearinghouse will reject a claim the same day for coding errors, so you are not waiting a week to learn about the denial. In the event a claim is denied for allegedly being submitted untimely, a simple check with the clearinghouse confirms the date the claim was submitted, and assists with filing an appeal.

Skyline Medical Billing Management wants to help your Prescott medical practice succeed, and offers ease of billing submission, the ability to instantly check the status of a claim, and reduce the time for reimbursement. If you are considering outsourcing your medical practice billing, call the medical billing experts at Skyline Medical Billing Management at 928-227-1167 for a consultation. Visit us online at https://www.skylinembm.com for more information.

ADDITIONAL INFORMATION
Prescott Business Development
Claims Processing in Prescott
Helpful Articles