Waive Good-Bye to the Critical Eyes of Insurance Investigator Joe!

2011 September 21 by

Doctors – Do you think it is okay for you to waive all co-pays and deductibles?

I was at a baby shower this past weekend and the lady next to me was talking about going to her Chiropractor. Then she went on to say that since the co-pay on her insurance is so high he does not charge her. He also told her that it was his choice whether or not to charge her because this was just extra money in his pocket. Insurance Investigator Joe would like to know this about her doctor.

Technically, it is not extra money in his pocket and he DOES NOT have the option of whether or not he/she routinely waives patient’s co-pays and deductibles. A co-pay is simply the balance of the actual charge, or allowed amount, that was not paid. It is not extra money. Any doctor/biller who thinks this way, needs a class in insurance 101 and a good lawyer.

In most states, it is illegal to routinely waive co-pays and deductibles for patients. This practice may initiate charges of health care fraud against the doctor because they are claiming the wrong amount of the service when the insurance is billed. For example, if a patient has a $40 co-pay that the doctor waives, and the insurance company is billed $100 and pays $60, technically the patient’s bill is only $60 total, not $100.

In the case of financial hardship, doctors may choose not to collect debts from patients without risk of being charged with insurance fraud. Reserve this ONLY for patients who are suffering a financial crisis or emergency.

KEEP EXCELLENT RECORDS of all conversations with the patient as evidence that you made a good faith effort to comply with the law and that co-pay and deductible exceptions were only made for specific reasons. Gather all the information you can about their financial situation. Set up a program with specifics on the care program, charges and discounts provided over a defined period of time.


Share this:
Share this page via Email Share this page via Facebook Share this page via Twitter

no comments

EMR EHR what the heck do I do now?

2011 September 13 by

EMR EHR what the heck do I do now?
5 Questions to ask yourself when deciding upon Electronic Medical/Health Records

1. Incentive Money??? The Medicare and Medicaid EHR Incentive Programs require the use of certified EHR technology. This entails standards, implementation specifications, and certification criteria for EHR technology that have been adopted by the Secretary of the Department of Health and Human Services. EHR technology must be tested and certified by an Office of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB) in order for a provider to qualify for EHR incentive payments. The WritePad Software that we offer is certified complete.
Check the list here: http://onc-chpl.force.com/ehrcert

2. Is there an EMR/EHR software program made just for my specialty? This could save time inputting information. Before you purchase a “well rounded” program, double check to see if there is one just for your practice type.

3. Is the EMR/EHR customizable? Is it possible to set up the software to how you run your office? If you have to change your office to fit the program – your increased frustration level will prevent you from getting the most from the software.

4. Are there many ways to randomize your notes so they are not all the same, even though the data you put in may be the same? Are changes easy to make? Can notes be edited? You want easy access to old notes and the ability to add/subtract or alter the notes on the fly.

5. Does the EMR/EHR work with my practice management system to reduce staff time inputting information? Making drastic changes to the office takes time and money (way more than you would think). Look for software that integrates with your current programs.

These are only a few of the questions you have to ask your vender and yourself before you make the change to EMR. Implementation of any system is done best if you can organize a quick and timely start up period.

We are here to help you. We offer E-Thomas Practice Management Software and WritePad EMR Software. Working together, all the above questions (and many more) have been answered with a resounding WOOOHAA!

Call our office for details (248) 997-8641

Share this:
Share this page via Email Share this page via Facebook Share this page via Twitter

no comments

Using the new ABN

2011 August 26 by

The latest version of the Advanced Beneficiary Notice (ABN) is now available for immediate use and can be accessed via the link below. You can distinguish this form from the older form because the release date of 3/2011 is printed in the lower left hand corner.


In order for providers and suppliers to have time to transition to using the newly posted notice, mandatory use of this version begins on November 1, 2011. All ABNs with the release date of 3/2008 that are issued on or after November 1, 2011 will be considered invalid.

The ABN form is designed to be used when Medicare rules are not met. Medicare recognizes that some non-covered services are beneficial to the patient. The form is used to inform patients of their choice to receive services, knowing that they might have to pay for them.

An important tip is to be completely upfront with the patient about the fees that they are responsible for. Give the patient the opportunity to decide before you provide the service. This will ensure that the patient understands their financial obligation to the office.

Here’s the proper protocol in filling out the form:
• Complete ABN forms with the patient’s name and Medicare health-insurance number
• Include the service that Medicare will likely deny in the appropriate box
• Include the reason you anticipate the denial in the appropriate box
• The provider may estimate the cost for the service.
• If a patient requests an estimate, providers should complete the form to the best of their ability.
• However, not including a price does not automatically invalidate an ABN.
• Beneficiaries must select one of the following options on the form:
YES: receive the services affected by coverage limitations
NO: decline the services
• Date the form and have the beneficiaries (or their representatives) sign it

This tip was excerpted from ABN Training Handbook for Hospital Staff and Physicians, Copyright 2004 by HCPro Inc.


Share this:
Share this page via Email Share this page via Facebook Share this page via Twitter

no comments

HIPAA 5010 What? Why? When?

2011 July 13 by

HIPAA 5010 What? Why? When?

The simple answers to the questions of HIPAA 5010

What? HIPAA 5010 is a government regulation

Why? Because they can

When? On or before January 1, 2012


In January 2009, the Department of Health and Human Services published its final rule
replacing HIPAA Accredited Standards Committee (ASC) X12 version 4010A1 with ASC
X12 version 5010 and National Council for Prescription Drug Program (NCPDP) 5.1 with
NCPDP version D.0.

What this means is that all “covered entities” –including providers, payers/health plans, clearinghouses, and billing and service agents — must be compliant with new standards for electronic transactions by the end of the year. All HIPAA electronic transactions, including claims submission, remittance advice, eligibility, claim status, authorization referrals, and others must be using the upgraded 5010 version by January 1, 2012.


Currently the standard for transactions is 4010. Concurrency is the best practice for HIPAA 5010, given the likelihood that there will be a fairly long period during which organizations will be dealing with both kinds of codes and all insurance companies will not have their systems ready at the same time to accept the new 5010 files.

Check with your software vendor to see where they are in updating your practice management software. The program that we are a reseller for, Genius Solutions e-Thomas, has already released their update and it gives you the ability to send both 4010 and 5010 claims. If you have Genius Solutions, make sure that you have done your update or call the support department if you need help.

External testing should be performed with your clearing house, billing service (preferably Michelle’s Billing Service, Inc.) and payers to ensure proper transmission of your transactions.


You need to review how you have entered your patient insurance information in your computer system.
• For health plans that assign a unique identifier per member, the individual must be listed as the subscriber.
• For health plans that assign a number to the entire family, the policy holder is always listed as the subscriber.

If you have any questions or comments, please feel free to contact Michelle at 248-997-8641, or use the link on this page.

Remember: insurance benefits, rules and billing procedures change constantly. We are here to help you!

The AMA has a good site to help you with more resources

Share this:
Share this page via Email Share this page via Facebook Share this page via Twitter

no comments

HHS Announces $750 Million Investment in Prevention

2011 February 10 by

Tue, 08 Feb 2011 23:01:00 -0600

Department of Health and Human Services Secretary Kathleen Sebelius today announced a $750 million investment in prevention and public health, funded through the Prevention and Public Health Fund created by the new health care law. Building on $500 million in investments last year, these new dollars will help prevent tobacco use, obesity, heart disease, stroke, and cancer; increase immunizations; and empower individuals and communities with tools and resources for local prevention and health initiatives.

Comment:  The health care revolution begins with little steps.  $750 million is a leap!  As providers it is important to start with something we can handle in our office, ourselves.  What can you do today to make sure that you’re better tomorrow?

Share this:
Share this page via Email Share this page via Facebook Share this page via Twitter

no comments

What is the NACC and why do I need to join?

2011 February 7 by

NACC stands for many things if you do a search for it in Google. However, we are referring to the National Association of Chiropractic Coders. It is an organization founded by Dr. Ted Arkfeld D.C. CPC (need additional credential info) to train Chiropractors and their staff on correct documentation and coding.

Share this:
Share this page via Email Share this page via Facebook Share this page via Twitter

no comments