Overview of Radiology Billing (Global, Technical and Professional Components):

Transcription

1 Overview f Radilgy Billing (Glbal, Technical and Prfessinal Cmpnents): GLOBAL RADIOLOGY FEE: Fee cnsists f bth Technical (taking the XR) and Prfessinal cmpnents (Interpretatin f XR). If Dctrs bills x-ray cde WITHOUT a mdifier, the carrier pays bth fees t the Referring Dctr and PIC has t bill the patient r dctr fr ur fee Example: is GLOBAL CODE fr 2 lumbar x-rays. TECHNICAL COMPONENT: If PIC is t bill separately, the DOCTORS ffice must add TC mdifier t the x-ray cdes. Example: TC PROFESSIONAL COMPONENT: If PIC bills the carriers separately, we bill with the Prfessinal Cmpnent Mdifier -26. Example: *Please nte that patients need t sign ur authrizatin frm especially if we are billing separately. Yu can use ur frm (see nline) r create a frm mre friendly frm fr yur ffice. Yu can send the frm r keep it in the patients file in yur ffice.

2 HOW TO USE THE TIME OF SERVICE FEE REDUCTION: CLINICS SENDING HARD X-RAYS (NON DIGITAL) SHIPPED BY MAIL/UPS: Have the patient write a check, send cash, mney rder r send credit card/ debit card (VISA / MASTERCARD FORM WILL BE AVAILABLE ON INTERNET FOR DOWNLOAD) Put the payment in with the patient s X-Ray jacket with the billing frm CLINICS SENDING DIGITAL IMAGES (TELERADIOLOGY): Digital patients are mre f a challenge. I am lking int nline payment grups such as PayPal. Until that is finalized, there are a cuple f ways this can be handled: Patient can write a check (made ut t PIC) and give t the dctr s ffice. Dctr s ffice can send checks t PIC later that week (alng with any ther TOS checks). Patient can give SIGNED Credit card /debit card infrmatin (using ur frm r yurs) which can be faxed r scanned / ed t ur ffice. OR *Either way, when the Billing Histry frm is faxed fr the patients wh prepay, please indicate that it is a TOS patient (tp f the frm). PLEASE NOTE: IF NOT INDICATED n the billing frm / infrmatin sheet that the patient has chsen the time f service reductin, patients will be billed at the standard fee schedule.

3 BILLING OPTIONS FOR DOCTORS: 1. TIME-OF-SERVICE FEE REDUCTIONS (FOR INSURANCE, CASH, MEDICARE and PI PATIENTS) Patients pre-pay and take advantage f significant Time-f Service fee reductins Hard x-rays Sent by Mail: Payment included with patient x-rays (Check, cash, mney rder r signed credit card inf frm). Digital/Teleradilgy:. Patients can pay with Debit/ Credit card (fax cmpleted / signed VISA/MC billing frm). If Patient s nly have check r cash, the ffice can cllect the payment and mail t us at the end f the week. Or, the dctr can cllect the mney and send a check fr the ttal amunt. *Advantage: Less cmplicated than PIC billing separately. 2. PIC CAN BILL THE DOCTOR FOR ALL SERVICES (negtiated fee d/p n several factrs) Fee paid by dctr at the end f the mnth If hard x-rays, Dr can send check with films fr even greater discunt Dctr bills fr the glbal fee. *Advantage: Easier billing. Less cmplicated and less time cnsuming fr dctr s staff. In many cases, this will save mney fr the dctr (d/p n vlume f patients and bdy areas per patient). 3. PIC BILL THE CARRIERS FOR SOME PATIENTS AND BILL THE DOCTOR FOR OTHER PIC can bill fr sme patients but the dctr pays fr thers. DR may cllect fee frm patient. Example #1: Dr. pays (negtiated fee) fr Insurance, Cash, Medicare and Medicaid and WC. PIC bills and waits fr payment frm PI cases. Example #2: PIC bills fr PI, WC and Anthem but dctr pays fr all ther patients. *Advantages: I believe this ptin is the best f bth wrlds. Less cmplicated, less paperwrk fr the staff and less prblem with patient cmpliance. Dctr des nt have t pay and wait fr PI cases t settle. Multiple ptins are pssible depending n what wrks best fr the dctr s ffice. Dctrs can ften save mre mney than PIC billing separately CONTINUED

4 4. PIC CAN BILL INSURANCE, PI, WC, MEDICARE, MEDICAID, CASH etc., PIC will bill fr Prfessinal cmpnent using the -26 mdifier Referring dctr bills using the TC mdifier (technical cmpnent) Patient ultimately respnsible fr any utstanding balance including (but nt limited t) applicable deductibles, c-payments, denials, etc. *Advantage: Dr. des nt directly pay fr service but Dr. must bill w/ TC mdifier which reduces payment anyway. *Disadvantages: Increased paperwrk and mre cmplicated fr staff. Patients ften frget abut signing ur Release and questin the bill later. Less ptential savings rather than dctr paying fr the services as discussed abve.

5 BILLING POLICIES 1. INSURANCE, CASH, PI: Optins PIC will bill the insurance carrier, patient r attrney and will bill the patient fr utstanding balance including (but nt limited t) applicable deductibles, c-payments, denials, etc. We will wait fr PI cases t settle. OR Patients can pt fr the Time f Service fee reductin. This reductin ONLY applies t INSURANCE, PI MEDICARE and CASH patients and nt Medicaid r WC. 2. WORK COMP: ****SEE TIME OF SERVICE REDUCTION HEADING FOR MORE INFORMATION PIC bills using the -26 mdifier and the clinic bills with the TC mdifier. Secnd Opinins fr wrk cmp (MRI r X-rays) must have prir (C9 frm in OH) apprval sent with the billing infrmatin 3. MEDICARE Medicare will nt pay fr DACBR reads. Sme secndary plans and Medicare Managed plans pay. PIC will bill Medicare and any secndary plans (if available). Patient will usually have t pay the bill in mst cases Time f Service Reductin is available and recmmended since it will cut the cst t the patient. 4. MEDICAID OHIO: We will bill fr State Medicaid and Managed Care Plans (e.g., Buckeye Cmmunity and Caresurce). CARESOURCE DOES NOT pay fr DACBR reads. If yur clinic has higher percentage f Caresurce, PIC may request that the dctr pay fr thse cases. Nn-Ohi Medicaid Clients: Depends n each state. If the majrity f the cases sent are frm nn-paying Medicaid prgrams, PIC may have t bill the dctr since we are usually prhibited frm billing the patient. 5. CASH (Uninsured, high deductible, etc.) We will bill the patient directly at ur regular fee schedule Strngly recmmend they take advantage f the TOS reductin r Dctr can pay If dctr perfrms a reprt and sends films, PIC will bill fr secnd pinin t the patient (NOT insurance cmpany etc.) FINANCIAL HARDSHIP CASES: A separate frm needs t be cmpleted and sent with x-rays r faxed (digital images) t get any fee reductins. Call ur ffice and we will fax r the frm.

6 BILLING POLICIES: CONTINUED 6. SECOND OPINIONS (PI, INSURANCE, WC): - Many dctrs want t send X-rays and/r MRI r CT S fr a secnd pinin. - Secnd Opinins billed if reprt already generated by the dctr r anther radilgist. - Please check the Secnd Opinin sectin f the Billing frm if we are t bill fr a secnd pinin. HEALTH INSURANCE COMPANIES: DO NOT PAY FOR SECOND OPINIONS. Patients will be treated as Cash patients and can use the TOS reductin r will be billed at standard fees. Dctrs can als chse t be billed r pre-pay. WORKER COMP (OH): OFTEN PAY FOR SECOND OPINIONS BUT ONLY WITH C9 APPROVAL. SELF INSURED USUALLY DO NOT PAY FOR SECOND OPINION READS! Fr OH wrkers cmpensatin, C9 apprval letter/frm MUST accmpany the imaging studies. Each state varies s nn-oh dctrs will need t get pre-apprval r can take advantage f TOS if it is a nn-cvered service. PERSONAL INJURY: Aut Insurance (with r w/ attrney): Aut insurance ften pays withut pre-apprval but varies state by state. If denied we will bill the patient and/r the attrney (if represented) ATTORNEY ONLY: If an attrney (w/ Aut Ins), we will send the attrney the bill and wait fr the case t settle.