Billing Q&A
Q. Should bills be mailed to patients while the hospital is still in the process of billing the insurance carrier?
A. With the exception of Medicaid and Worker’s Compensation, you are allowed to do so. Some hospitals do not sent bills to patients because of the inquiries that the statements generate. Patients may not understand that you are waiting for the insurance carrier to pay. Some computer systems do not provide adequate verbiage on the patient’s statements to explain that the bill is not an indication that the patient should, at the time, pay the balance of the account. More sophisticated systems can prorate the expected amount to be paid by the carrier and can indicate the patient’s portion.
The best reason to bill the patient is to keep him informed that the bill is still outstanding and that failure of the insurance carrier to provide prompt payment will result in him being required to pay the total charger.
Q. Should contractual adjustments be made at the time the claim is filed?
A. Your ability to properly calculate the adjustment amount and apply it to the account will be the primary determining factor. Properly programmed, most data systems can provide this function. There are some drawbacks, however. Claims that are rejected can cause an accounting nightmare. The reverse adjustments can be confusing to patients as well as to readers of the general ledger. On the other hand, it can be a great tool in reducing the aged trial balance and thus reducing your days in receivables.
Q. When an insurance carrier fails to pay the claim within the allowed time frame, how should the patient be notified he is now responsible for the balance?
A. Some hospitals depend on a message placed on the data mailer. If the patient has been receiving statements during the insurance billing process, he may not take the time to read the entire statement. If he receives his first data mailer after you have changed the account to self-pay, he may read the statement asking him to pay. The absolute best way to inform the patient of his obligation is to send a properly worded letter stating what has happened to his account. If the letter, in its envelope, looks different from the data mailer, he is more apt to open it and read the contents. Remember, billing the patient in this manner does not mean that the insurance carrier will not pay the claim. You will be enlisting your best help, the patient, to get insurance to pay.
Q. In liability cases where attorneys have intervened but refused to provide a letter of protection, is it OK to look to the patient for payment?
A. Existing law tends to allow this. However, as in most legal cases, caution is the best advice available. The two alternatives are:
- Make sure you have properly filed your hospital lien. This is your best protection for receiving your portion of any settlement. (See article on liens.)
- The other alternative would be, upon refusal of the attorney to provide you with assurance of protection in the form of his letter, to immediately file suit against the patient for the amount owed. This action should be reserved for large balance accounts and cases where the patient’s attorney is extremely hostile.
Q. Is it possible to have automobile PIP insurance benefits paid directly to the hospital?
A. Yes, but there is a slight catch to the acceptable procedure in billing the claim. We have been advised that the standard automobile policy in Texas has a stipulation that the bill for services must be accompanied by an assignment of benefits. This does not mean a UB-92 that has the statement at the bottom “signature on file.” You must submit a copy of the official assignment of benefits from your admission packet. The problem is that, in most hospitals, this form is no longer a part of the business office file. It remains with the patient’s chart and goes to medical records. If this is the case at your hospital, you must retrieve a copy and remit it with the claim. Otherwise the PIP benefits will be paid to the patient.
In all cases where there is a legal question, consult legal counsel.
We’re always happy to try and assist whenever people have receivables-related questions. If you have a specific question, don’t hesitate to contact us.
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