Practice Management Alert

The Employee Retirement Income Security Act (ERISA) mandates that carriers respond to appeals only from a member or a member's personal representative. You can facilitate your appeals process by asking every patient to make your provider his personal representative for insurance purposes. Add this clause to your assignment-of-benefits form to accomplish the task with ease: "I authorize Dr. X to be my personal representative, which allows Dr. X to: (1) submit any and all appeals when my insurance company denies me benefits to which I am entitled, (2) submit any and all requests for benefit information from my insurance company, and (3) initiate formal complaints to any state or federal agency that has jurisdiction over my benefits. I fully understand and agree that I am responsible for full payment of the medical debt if my insurance company has refused to pay 100 percent of my benefits, within ninety (90) days of any and all appeals or request for information. I also agree that any fines levied against my insurance company will be paid to Dr. X for acting as my personal representative." -- Provided by Steven Verno, CMBS, compliance director for the Medical Association of Billers based in Las Vegas.