Urgent: Who to bill?
Joe
Description
Collection
Title:
Urgent: Who to bill?
Creator:
Joe
Date:
11/3/2000
Text:
Yesterday was one of those days were one shakes their head in disbelief
and wonders
how it all comes together.
A local hospital where I fit many orthotic braces, both custom and off
the shelf, has declined to provide a P.O. for billing and the case
manager asked me to bill the insurance company (or Medicare) of the
patient's directly. I informed the case manager that to do so I would
need
an authorization from the insurance company which is initially generated
by the prescribing physician's office, whereby the insurance company
faxes us the auth. The hospital is not doing to do that she says.
Have any of you been asked to do the same? Bye the way, the case
manager said that if we don't do it she knows of a company that will.
Their stance is that since they are capitated they are not going to get
paid for the
brace. I say that the ins co. expects the hospital to cover the costs.
The ins co. in not likely to pay us for services performed in the
hospital when the hospital has already been paid via the capitated
rate. My understanding of capitation from my Managed Health Care course
is that
braces are rolled into the capitation figure for a given procedure. One
patient needs a
cervical collar and one needs a Halo for a given cervical procedure. One
patient needs a LS corset and one needs a body jacket for a given
cervical procedure. The hospital pockets money on the collar and corset
order
and may not make as much money on the halo and body jacket order. But in
the end
they make money on the averages.
My marching orders are that without a PO I can't bill the
hospital;without an authorization by the Ins.Co. I can't bill the
Ins.Co.
I think Medicare cases require me to bill the hospital if they ordered
it and the item is fit within
a certain window of time after the patient leaves the hospital. Past
that window of time I can bill Medicare. On this I need clarification.
Joe Harvey NCOPE resident
and wonders
how it all comes together.
A local hospital where I fit many orthotic braces, both custom and off
the shelf, has declined to provide a P.O. for billing and the case
manager asked me to bill the insurance company (or Medicare) of the
patient's directly. I informed the case manager that to do so I would
need
an authorization from the insurance company which is initially generated
by the prescribing physician's office, whereby the insurance company
faxes us the auth. The hospital is not doing to do that she says.
Have any of you been asked to do the same? Bye the way, the case
manager said that if we don't do it she knows of a company that will.
Their stance is that since they are capitated they are not going to get
paid for the
brace. I say that the ins co. expects the hospital to cover the costs.
The ins co. in not likely to pay us for services performed in the
hospital when the hospital has already been paid via the capitated
rate. My understanding of capitation from my Managed Health Care course
is that
braces are rolled into the capitation figure for a given procedure. One
patient needs a
cervical collar and one needs a Halo for a given cervical procedure. One
patient needs a LS corset and one needs a body jacket for a given
cervical procedure. The hospital pockets money on the collar and corset
order
and may not make as much money on the halo and body jacket order. But in
the end
they make money on the averages.
My marching orders are that without a PO I can't bill the
hospital;without an authorization by the Ins.Co. I can't bill the
Ins.Co.
I think Medicare cases require me to bill the hospital if they ordered
it and the item is fit within
a certain window of time after the patient leaves the hospital. Past
that window of time I can bill Medicare. On this I need clarification.
Joe Harvey NCOPE resident
Citation
Joe, “Urgent: Who to bill?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/215402.
