I. Policies and Procedures for Clinic’s Billing and Coding
1.1 Staffing:
Adopted on: March 21, 2019
Approved by: Vasilios Nenos
Policy: Required staff at North Tampa Chiropractic to ensure smooth operation of the office.
Procedure: At North Tampa Chiropractic the minimum amount of staff on site is/are one (1) treating physician, and one (1) front desk person. This is the minimum necessary to open the office for that day. There will normally be an extra front desk person, and one (1) chiropractic assistant (CA) working.
A. The front desk person will distribute and explain the new patient paperwork and
collect and organize the paperwork and input basic information into the patient
profile. The front desk worker will also be in charge of patient check in.
B. The CA is an extension of the doctor that can provide active and passive
treatment help after the treating physician has started the treatment. The CA is
also responsible for some tasks they are trained for, that the treating physician is
not able to do.
B. The collections process is to collect the co-pay/cash from the cash patients.
Cash patient collection is explained below (see 2.1 Cash Patients). Insurance co-
pays collection is explained below (see 2.2 Major Medical Insurance & 2.3
Medicare). If the balance is not paid within 7 days, the treating physician will
place a call to that patient, reminding them. If this is not paid, a written letter will
be mailed on the tenth day. If the bill is not paid, then on the 15th day the
patient’s bill will be sent to collections.
C. Must have at east one female employee on staff present on premises at all
times, if a female patient is being treated, a female must always be in the room.
1.2 Patient Sign In:
Adopted on: March 21, 2019
Approved by: Vasilios Nenos
Policy: Patent sign in at North Tampa Chiropractic for documentation of arrival.
Procedure: All patients must sign in at the front desk and will be told how long approximately the wait is. The employee at the front desk is responsible for all check-ins and will mark the patient as arrived in the electronic health record (EHR)
1.3 Review of New Patient Paperwork:
Adopted on: March 21, 2019
Approved by: Vasilios Nenos
Policy: Reviewing new paperwork at North Tampa Chiropractic for new patient safety.
Procedure: The chiropractic assistant (CA) will look over the new paperwork either before or after the treating physician and mark any red or yellow flags as explained by the doctor.
1.4 Insurance Verification:
Adopted on: March 21, 2019
Approved by: Vasilios Nenos
Policy: Insurance verification at North Tampa Chiropractic to ensure patient is properly insured.
Procedure: Upon the patient’s first arrival, or the review and update date, the patient must bring their insurance card, and a valid state given identification. The patient’s identification will be verified, and a copy of the identification and insurance card will e maid and added electronically to their file.
II. Policies and Procedure for Each Type of Patient
2.1 Cash Patients:
Adopted on: March 21, 2019
Approved by: Vasilios Nenos DC
Policy: Treatment for cash patients at North Tampa Chiropractic and payment.
Procedure: All cash patients pay in full after services are rendered at that visit if the patient does not follow procedure see 1.1B.
2.2: Major Medical Insurances:
Adopted on: March 21, 2019
Approved by: Vasilios Nenos DC
Policy: All major-medical insurance companies will be accepted at the terms of the individual insurance plans.
Procedure: We accept major insurance. Blue Cross Blue Shield, Aetna, First Choice Health, Cigna and workers compensation insurances will be accepted. Each company may have a different scaled co-payment that will be required at the time of service. This contract is between the insured and the insurance company, not between North Tampa Chiropractic and the insurance.
2.3: Medicare:
Adopted on: March 21, 2019
Approved by: Vasilios Nenos DC
Policy: Procedures for Medicare (Plan B) patients.
Procedure: Medicare patients in need of treatment will be accepted. All Medicare patients must provide co-payments at the time of service. Medicare will be billed as soon as an AT date is generated. An ABN form must be signed and agreed to by the patient in order to receive services. It is the responsibility of the treating physician to explain the ABN to the patient and explain any possible fees that are not covered by Medicare.
2.4: Indigent Policy:
Adopted on: March 21, 2019
Approved by: Vasilios Nenos DC
Policy: Discounted services by way of financial services may be offered if patient qualifies.
Procedure: Patient must provide most recent W-2 form as well as proof of gross income. Any extra necessary information will be asked of the patient and can be evaluated by either physician or billing staff member. Financial hardship form will be presented and explained to by billing or front desk staff and must be signed by the patient following explanation. The clinic director or office manager and billing analyst will review all paperwork submitted. They are responsible for the final decision; there is no appeal to this process.
2.5: Personal Injury Cases (MVA/WC/PI):
Adopted on: March 21, 2019
Approved by: Vasilios Nenos DC
Policy: Procedures for any personal injury case/worker’s compensation.
Procedure: For motor vehicle accidents (MVAs), injuries taking place at work, worker’s compensation, and/or personal injury care patients, the patient must provide a copy of work insurance, auto insurance, personal and or health insurance cards. Each doctor must be informed if an attorney has been obtained. Payments will be handled by means of:
A. Billing to the auto insurances medical policy
B. Billing to the worker’s insurance medical policy
C. A Letter of Protection will be accepted if an attorney is involved, therefore allowing a postponement of payment by the patient until a settlement has been established within the court of law.
D. Insurance company coverage must be verified.
E. Billing will be processed corresponding to the particular company policies.
F. Cash payment for care/treatments and the office will submit appropriate documentation
G. Any additional fees will be told to patient immediately
III. Patient Responsibilities
3.1: Patient Responsibilities:
Adopted on: March 21, 2019
Approved by: Vasilios Nenos DC
Policy: Insurance Information, Co-pays, Reimbursement, & Missed Appointments
Procedure:
– In order to use insurance, patient must have current card on file, no exceptions. If the patient does not have card, full fee will be charged to patient. There will be no post hoc reimbursement to the patient if it is brought on following visits.
– Patients will be required to pay any co-pays and or balances not paid by insurance.
– Payment plans are available if patient needs flexible fees.
– Patient information must be as up-to-date as possible.
– Patients will get two (2) grace period missed appointment passes. However, patients will be charged $30 for any “no show” appointments for failing to show up to a scheduled appointment without giving 24-hours notice.
3.2: Personal Data:
Adopted on: March 21, 2019
Approved by: Vasilios Nenos DC
Policy: Patients are required to answer both health and intake information to the best of their ability. All patient information is required to be kept confidential under HIPAA rules and regulations.
Procedure: Each employee of North Tampa Chiropractic receives HIPAA training. Each employee who performs training through HIPAA shall submit a signed document acknowledging its completion. Each employee will be required to follow the HIPAA training modules and complete the training before employment.
References:
– https://www.ncmic.com/learning-center/articles/patient-experience/billing-and-fees/establishing-a-fee-schedule/
– https://www.hhs.gov/hipaa/for-professionals/training/index.html
– https://www.ncmic.com/learning-center/articles/patient-experience/payments-and-collections/words-of-wisdom-about-cash-only-practices/
– https://www.ncmic.com/learning-center/articles/patient-experience/payments-and-collections/collecting-patient-fees/
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