Q) My practice treats quite a few patients for injuries sustained at work or in auto accidents. Are there any tips for managing these cases after the insurer has denied any further billing reimbursement for reasons like an IME denial, or exhausted benefits?
A) Yes, there are things you can do following a denial that will help you monitor these cases.
Determine whether the patient has obtained an attorney to pursue further action on the case. If so, the Chiropractic or Physical Therapy provider needs to establish, or maintain, an ongoing positive relationship with the attorney and his or her team.
Establish a calendar for your clinic team to make contact with the attorney’s team at a minimum frequency of once per month, so that you can keep the attorney apprised of the patient’s current clinical status and the amount of the remaining balance on the account. The attorney’s team should keep you updated when there are critical steps coming up, like an Arbitration or hearing, or settlement negotiations.
About 10-14 days prior to this event, you should provide the attorney with up to date medical records and an itemized billing statement. Even though it is perfectly acceptable to charge the attorney for your medical records, many providers realize that by providing records and bills at no charge to the patient’s attorney, they are helping their ally to get their clinic’s bill paid. In this world of electronic health records, there is no longer a need for the clinic staff to spend much time or resources on sending updates to the attorney.
If the denial is not a Primary Denial of Liability or a Benefits Exhausted denial, you will want to continue sending current billing statements, or claims, to the insurance company – to keep them aware of the continuing treatment. Treatment that occurs after a denial may be billed to the patient’s private health insurance and the requirements for that billing will vary with the insurance company, so check with that insurer to see what they will need from you or the patient before submitting any bills to them.
In cases where the patient will not be employing the services of an attorney, it is important for the Chiropractic or PT provider to implement a financial agreement with the patient for ongoing services to be paid by the patient, or a the private health insurance for the patient.