Choose Between 2 Plans to Get School Physical Reimbursement Rolling
Published on Fri Oct 05, 2007
Tip: Consider combining physician services to make the most of physician time
Stop sacrificing payment or, worse, patient satisfaction when it comes to school, sports and camp physicals. You can collect for these services without fraudulently billing a preventive exam. Get a jump on these exams by following these three best practices. Option 1: Collect From the Patient When a patient comes in for a school or camp physical that his carrier won't cover, you can collect from the patient directly.
-My suggestion is that these are treated as -self-pay- services and offices should collect up front,- says Christy Neff, RMC, physicians billing specialist for Witham Health Services in Lebanon, Ind. -If the patient/parent insists that insurance will cover the exam, we can file a claim, and then if insurance does pay, we will reimburse the patient/parent.-
First step: Inform parents that, unlike annual preventive medicine services, sports and camp physicals are usually noncovered services and their payer may not pay for the service, says Charlene Burgett, MS-HCM, CMA, CMM, CPC, CCP, CMSCS, administrator for North Scottsdale Family Medicine in Arizona. Then, you can charge the parent or guardian up front when your physician fills out school or camp paperwork and/or performs a noncovered physical exam.
Tip: If you-re billing the patient directly for a non-covered service like this, you don't need to submit anything to the insurance company. If the patient insists that you do, however, you should submit the claim.
Many patients have the misconception that payers will pay for everything, and when you tell them something is not covered, they don't believe you. For good patient relations in these cases, bill the claim. Indicate in the appropriate field of the claim the reason for the claim submission, such as -need denial for secondary insurance- or -need denial for patient.- If you-re billing to Medicare in order to get a denial, be sure to append modifier GY (Item or service statutorily excluded, does not meet the definition of any Medicare benefit or for non-Medicare insurers, is not a contract benefit).
Best bet: -When in doubt, have the patient pay up front, submit the claim to the insurance, and if they pay, you can reimburse the patient,- Neff says. Option 2: Combine an Annual and School Physical You can recoup preventive exam pay if your patients present for their annual exam when they require a sports or camp form. Encourage parents to schedule their child's annual physical around the time that they-ll need forms filled out for school or camp.
-If the child is due for a normal well child check, we will typically perform that service and just fill out the camp/sports/school physical at that time,- Burgett says.
Good news: Some insurers cover [...]
