Making patients do their own Prior Auth's and Billing...

[drusso]

Anyone doing this? Some practices are giving patients the paperwork, making them "pre-pay" for services, and then reimburse them when the insurance pays. Apparently, it really pisses the insurance companies off, but gives patients a whole new appreciation for how whacked our system is...also cuts down on overhead.

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[yankeeh8r]

Anyone doing this? Some practices are giving patients the paperwork, making them "pre-pay" for services, and then reimburse them when the insurance pays. Apparently, it really pisses the insurance companies off, but gives patients a whole new appreciation for how whacked our system is...also cuts down on overhead.

Every psychiatrist, psychologist, and therapist I know does it this way. Essentially, they'll fill out the part of the form with the codes for the service and how much the patient paid for the service. The patient fills out the top part with their insurance and demographic information, then carries the load with faxing/mailing the form in and harassing the insurance to get their reimbursement and/or credit to their deductible. I'll tell you, every one of them says it works. Their overhead is minimal. The insurance companies hate it because pissing off the "actual customer" isn't something they like to do and (as we all know) some people have all the time in the world to harass their insurance carrier. I can tell you I've had patients start calling their insurance when we've had problems with a prior auth and it has worked. I had one guy with a compression fracture who said he had nothing better to do than lay in bed and call the insurance company every hour telling them how much agony he was in and how he needed them to expedite the approval for his kyphoplasty. And it worked.

 

[drusso]

Every psychiatrist, psychologist, and therapist I know does it this way. Essentially, they'll fill out the part of the form with the codes for the service and how much the patient paid for the service. The patient fills out the top part with their insurance and demographic information, then carries the load with faxing/mailing the form in and harassing the insurance to get their reimbursement and/or credit to their deductible. I'll tell you, every one of them says it works. Their overhead is minimal. The insurance companies hate it because pissing off the "actual customer" isn't something they like to do and (as we all know) some people have all the time in the world to harass their insurance carrier. I can tell you I've had patients start calling their insurance when we've had problems with a prior auth and it has worked. I had one guy with a compression fracture who said he had nothing better to do than lay in bed and call the insurance company every hour telling them how much agony he was in and how he needed them to expedite the approval for his kyphoplasty. And it worked.

Will everyone on this board please commit to start doing this today? Just imagine the profound impact we would make in the name of patient-centered health care...

 

[Ligament]

I need to learn more. Russo, please email me details!

I am just now implementing this policy, which is NOT as good but may be a middle road; we get things taken care of but don't have to pay for it:

If your insurance requires this office to obtain "pre authorization" or "prior authorization" for medical care, you will personally be responsible for $10.00 to cover this cost. This must be paid in advance prior to any "pre authorization" or "prior authorization" action by this office. There is no guarantee that your insurance will make an approval based on this "pre authorization" or "prior authorization."

If your insurance requires this office to generate a "letter of medical necessity" for medical care, you will personally be responsible for $35.00 to cover this cost. This must be paid in advance prior to a letter of medical necessity being generated by this office. There is no guarantee that your insurance will make an approval based on this letter of medical necessity.

If your insurance requires this office to make an "appeal" for medical care, you will personally be responsible for $50.00 to cover this cost. This must be paid in advance prior to an appeal being generated by this office. There is no guarantee that your insurance will make an approval based on this appeal.

If your insurance requires that our physician make a "peer to peer" phone call for medical care, you will personally be responsible for $75.00 to cover this cost. This must be paid in advance prior to a "peer to peer" phone call being made. There is no guarantee that your insurance will make an approval based on this "peer to peer" phone call.

Failure to cancel an office/clinic appointment within 24 hours of the appointment will result in a cancellation or “no show" fee charge of $150.00. Failure to cancel a pain injection procedure scheduled in a surgery center, hospital, or fluoroscopic suite within 24 hours of the appointment will result in a cancellation or “no show" fee charge of $300.00.

 

[specepic]

I have started an approach where I am willing to only commit so much of my time and the staff's time to certain auth endeavors. If I was PP I would seriously consider trialing a model as described above but Im hosp employed. Once we have tried and another hoop is thrown up, I turf it to the patient "call your insurance, we have done what is reasonable". I think that is fair, I have personally witnessed my MA spend 2 hours with a state medicaid phone tree/employees trying to get Lyrica/MRI/shot approved

I know the feds want to move us away from pay for work, perhaps we should settle for pay for time like attys.

 

[jj337]

I need to learn more. Russo, please email me details!

I am just now implementing this policy, which is NOT as good but may be a middle road; we get things taken care of but don't have to pay for it:

If your insurance requires this office to obtain "pre authorization" or "prior authorization" for medical care, you will personally be responsible for $10.00 to cover this cost. This must be paid in advance prior to any "pre authorization" or "prior authorization" action by this office. There is no guarantee that your insurance will make an approval based on this "pre authorization" or "prior authorization."

If your insurance requires this office to generate a "letter of medical necessity" for medical care, you will personally be responsible for $35.00 to cover this cost. This must be paid in advance prior to a letter of medical necessity being generated by this office. There is no guarantee that your insurance will make an approval based on this letter of medical necessity.

If your insurance requires this office to make an "appeal" for medical care, you will personally be responsible for $50.00 to cover this cost. This must be paid in advance prior to an appeal being generated by this office. There is no guarantee that your insurance will make an approval based on this appeal.

If your insurance requires that our physician make a "peer to peer" phone call for medical care, you will personally be responsible for $75.00 to cover this cost. This must be paid in advance prior to a "peer to peer" phone call being made. There is no guarantee that your insurance will make an approval based on this "peer to peer" phone call.

Failure to cancel an office/clinic appointment within 24 hours of the appointment will result in a cancellation or “no show" fee charge of $150.00. Failure to cancel a pain injection procedure scheduled in a surgery center, hospital, or fluoroscopic suite within 24 hours of the appointment will result in a cancellation or “no show" fee charge of $300.00.

Sounds a little harsh... Seems like you would get harsh feedback from referring providers.

 

[EtherBunny]

Anyone doing this? Some practices are giving patients the paperwork, making them "pre-pay" for services, and then reimburse them when the insurance pays. Apparently, it really pisses the insurance companies off, but gives patients a whole new appreciation for how whacked our system is...also cuts down on overhead.

Sounds very reasonable to me! I would be willing to try it, if I weren't a hospital employee...

 

[nvrsumr]

when patients get denials I have them contact their work human resources dept to have them contact the insurance carrier directly. Seems to help.

 

[Ducttape]

my only concern would be how many patients would leave a practice if they had to do this. would this work in a very competitive market?

 

[emd123]

Anyone doing this? Some practices are giving patients the paperwork, making them "pre-pay" for services, and then reimburse them when the insurance pays. Apparently, it really pisses the insurance companies off, but gives patients a whole new appreciation for how whacked our system is...also cuts down on overhead.

I would consider this if my patients had any skill/desire/motivation/know-how to get this done. I ask them to bring their pharmacy drug formulary in and my success rate is <10%

I'm stuck with staff performed pre-approval, then chase-down-whatever-money-I-can-get-like-pit-bull and hope for the best approach. Sucks, but handing the responsibility over to my patients would mean nothing gets done.

Would be great with motivated patients.

 

[drusso]

I would consider this if my patients had any skill/desire/motivation/know-how to get this done. I ask them to bring their pharmacy drug formulary in and my success rate is <10%

I'm stuck with staff performed pre-approval, then chase-down-whatever-money-I-can-get-like-pit-bull and hope for the best approach. Sucks, but handing the responsibility over to my patients would mean nothing gets done.

Would be great with motivated patients.

I wonder if anyone (insurance companies, government payors, etc) should be spending resources on patients who aren't motivated...especially for something like pain management.

 

[Ducttape]

perhaps motivated is not the correct term. plenty of patients are motivated regarding pain treatment options, but not intelligent enough to discuss situation with their insurance carrier.

 

[Ligament]

Sounds a little harsh... Seems like you would get harsh feedback from referring providers.

It is indeed harsh, and I don't want to do it. But overhead is astronomical due to massive increase in denials/pre-auths/peer-to-peers thanks to Obamacare. Also, reimbursement is down.

 

[drusso]

It is indeed harsh, and I don't want to do it. But overhead is astronomical due to massive increase in denials/pre-auths/peer-to-peers thanks to Obamacare. Also, reimbursement is down.

I think requiring patients to do their own pre-auths, etc is the only way stakeholders will get the message that the social contract has changed. Physician offices can't be expected to do unfunded work any longer. If enough physicians get on board with doing it, and there's enough of a backlash, then there can be a conversation about how to finance and pay for unfunded work.

 

[Ligament]

I think requiring patients to do their own pre-auths, etc is the only way stakeholders will get the message that the social contract has changed. Physician offices can't be expected to do unfunded work any longer. If enough physicians get on board with doing it, and there's enough of a backlash, then there can be a conversation about how to finance and pay for unfunded work.

Well said.

Problem is that the Obamacare socialists don't want us to be paid for our work at all, much less paid for our busy work. I think they will be happy when we are paying THEM to work.

 

[SSdoc33]

I think requiring patients to do their own pre-auths, etc is the only way stakeholders will get the message that the social contract has changed. Physician offices can't be expected to do unfunded work any longer. If enough physicians get on board with doing it, and there's enough of a backlash, then there can be a conversation about how to finance and pay for unfunded work.

not having this sort of trouble with medicare, are you?

its those private insurances where the CEOs make 50 million a year.

wouldnt it be nice to get paid 100 bucks for every follow up, 150 bucks for every patient, and 200 bucks for every epidural. no crazy codes, pre-auths, no office staff running around like monkeys?

ive said it before, and ill say it again: SINGLE PAYER

 

[emd123]

not having this sort of trouble with medicare, are you?

its those private insurances where the CEOs make 50 million a year.

wouldnt it be nice to get paid 100 bucks for every follow up, 150 bucks for every patient, and 200 bucks for every epidural. no crazy codes, pre-auths, no office staff running around like monkeys?

ive said it before, and ill say it again: SINGLE PAYER

My practice is so medicare heavy it's pretty much like this. Lower fees but lower maintenance. Collections are much easier as medicare pays like clock work, unlike some of these ---hole private insurers that promise a few bucks more but make you fight tooth and nail for it, if they let you collect it at all. But then again medicare pays good on some things. $7000 on Kypho where some privates pay so little you'd take a loss, DME, etc.