Practice Management Alert

Tip: Don't assume your practice holds all the responsibility Question: If a patient (or a parent) does not give secondary insurance coverage proof at the time of service, is our practice responsible in the future to refund the money that secondary insurance paid him at a primary rate? Or does the practice have the right to keep the initial payment until the two insurances have recognized that primary/secondary coverage applies to their client and they work out the solution? If billing patients with primary and secondary insurance poses a challenge to your practice, you-re not alone. Knowing where practice responsibility ends and patient responsibility begins is the key to successful payment and fewer patient problems. Take a look at these three common questions -- with answers from the experts -- to get the scoop on what you need to do to ensure you-re on the right track with billing order. Question 1: Who's responsible for knowing primary vs. secondary information? There is no easy answer to this question, says Rebecca Marthaller, CMRS, owner of Lower Columbia Medical Billing in Longview, Wash. "If the patient has not notified the insurance carriers about the secondary, then no one will know about this situation," she says. Best bet: Verify a patient's insurance coverage before you bill the service. Verification means checking the patient's insurance information to be sure that a patient belongs to the group you-re billing and that her group and member identification are correct. You should obtain this information prior to the patient's initial visit when possible. "If the practice verifies eligibility and benefits prior to an appointment, sometimes the insurance companies will indicate that other insurance coverage exists," says Richard C. Blate, MBA, practice management adviser and owner of Richard C. Blate LLC, a practice management, reimbursement and health information technology consulting firm in Atlanta. "This should be a red flag for the practice to speak to the parent regarding the primary/secondary coverage for the patient." Smart tip: Take advantage of carrier Web sites to make insurance verification less time-consuming, Blate says. Find out which carriers you deal with have verification Web sites, and sign up for them. Some clearinghouses also offer verification services. "This shows that the office made a good faith effort to submit the claim correctly," Marthaller says. "I believe that in a court of law, if the office could prove that there was no way they could have known there was other insurance, then they would not be at fault." Here's how: Have good patient registration and insurance forms to collect all the information you-ll need. Make sure there is room for the patient to list a secondary payer. Ask front-desk personnel to look immediately at [...]