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June 2020 Client Newsletter


Occasionally patients call provider’s offices about statement balances.  There are multiple reasons:

  • No insurance received with charges.
  • Copay/deductible not collected on the date of service. 
  • Confusion about the difference between the copay amounts for PCP’s vs. specialists.  Commercial insurers usually do assign a higher copay for specialist care. 
  • Insurance denied payment because the insurance policy has expired.
  • The patient did not expect to be billed the amount their insurer assigned. Deductibles are now really high – some are $6,000-10,000. 

Whenever you receive such calls, consider offering the following:

  • The patient, their spouse, other family member, or their employer selected the plan. Not the provider.  Insurers processed the claim & indicated what was owed further. 
  • If they have insurance, did the patient give you, Cape, or the hospital their insurance information?  If not, that would explain why insurance did not pay.
  • If they have a question about their balance, they should call their insurance company. The patient’s insurer processed the claim and has all of the information to explain their plan to them.
  • If they still do not understand, then suggest they call us. It should be pretty rare when their insurance cannot properly explain why they have a balance. 

How can you help your Cash Flow and lower the amount owed on each patient statement?

  • ALWAYS verify patient’s insurance with the patient prior to every visit.   Even better, verify it with the insurance company electronically.  NaviNet, Availity, etc., have online access to make it easy.  They can also verify the remaining deductible amount.  This is the industry standard that ensures the patient has insurance & what it covers – or what it doesn’t cover. 
  • Collect all copays prior to the patient being taken to the exam room.  If they won’t pay prior to service, it is unlikely they will pay after.  There should be no cases when the copay is not collected in advance – it has been the industry standard for a long time.
  • If the patient has no insurance, collect the full self-pay balance prior to taking the patient to the exam room in whatever forms of payment you accept. 
  • Participate in Credit Card on File which gives you immediate ability to collect patient balances.  Many patients now agree to use it. 

Participation agreements (Medicare, Blue Shield, Aetna, UHC, CIGNA, etc.) that each provider signs, along with Federal and state insurance laws, require providers to collect those balances.  Absent documented financial hardship or other valid reasons, (e.g., OIG Opinions for EMS clients) routinely not collecting patient balances is considered an “illegal inducement” or other non-allowed action and result in large repayments or legal liability. 


Medicare FFS Claims: 2% Payment Adjustment Suspended (Sequestration)

Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act temporarily suspends the 2% payment adjustment currently applied to all Medicare Fee-For-Service (FFS) claims due to sequestration. The suspension is effective for claims with dates of service from May 1 through December 31, 2020.



From the CMS COVID-19 FAQ’s released this past week:

Question: Our ambulance uses an electronic patient care reporting device to record beneficiary signatures that authorize submission of claims to Medicare. We are concerned that a known or suspected COVID-19 patient using a touch screen to sign or holding an electronic pen or stylus could contaminate these devices for future patients and for ambulance personnel. Are we permitted to sign on behalf of a patient with known or suspected COVID-19?

Answer: Yes, but only under specific, limited circumstances. CMS will accept the signature of the ambulance provider’s or supplier’s transport staff if that beneficiary or an authorized representative gives verbal consent. CMS has determined that there is good cause to accept transport staff signatures under these circumstances. See 42 CFR 424.36(e). CMS recommends that ambulance providers and suppliers follow the Centers for Disease Control’s Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States, which can be found at the following link: ems.html. This guidance includes general guidelines for cleaning or maintaining EMS transport vehicles and equipment after transporting a patient with known or suspected COVID-19. However, in cases where it would not be possible or practical (such as a difficult to clean surface) to disinfect the electronic device after being touched by a beneficiary with known or suspected COVID-19, documentation should note the verbal consent.

2020 Client Newsletter Archive