Practice Management

Hello,

I am curious to see if others are experiencing this issue and if so, how are you handling this situation?

We have patients that will present in our imaging centers for high tech imaging service and will ask to be registered as self. They are paying up front for their service. Afterwards, they will contact the billing dept and request that a claim be filed to their insurance.

Since they requested at the time of service to be self-pay, we are have completely for gone the prior auth process and now the claim is denying for no auth, patient not responsible.

Of course, once the patient gets their EOB they want their money back

As a contracted provider, are we "on the hook" for that service or can we still hold the patient responsible because they requested to be self-pay?

Do we have to file a claim to the payer at the patients request, even though they presented as Insured Self Pay? Seems like I remember once upon a time, patients could be reimbursed from a payer themselves- I am not sure if that's still a possibility...

Should we have the patient sign a waiver stating they understand they are self-pay for services rendered?

Thank you!

Kim Smiley, CPC, RCC (She/Her/Hers)

Coding Manager

ph:  (317) 328-7256  |  fax: (317) 715-9955

kim@northwestradiology.com

I advise groups to have a patient sign a "statement" when they are choosing to be seen as a self-pay patient. The "statement" includes language that they are directing the practice to manage this encounter as a self-pay encounter and therefore the practice will not submit on the patient's behalf any claims to the patient's insurance provider. Should the patient choose to submit a claim to their insurance provider, the patient will individually assume and accept the outcomes of any decision made by their insurance provider as to the medical necessity or appropriateness of the procedure, and that the patient will individually assume and accept any financial outcome from that decision by their insurance provider with no recourse to the practice now or in the future regarding this specific procedure.

Have your attorney draw up a statement to that effect since state laws vary on how this needs to be developed. Once the patient signs then you simply tell them when they request a claim be submitted after the fact that you will not based upon the written direction that patient provided at the performance of the procedure....

People are becoming very savvy in how to not pay for their healthcare. I'm seeing this in other practices as well....  Hope this helps....

Hello,

I am curious to see if others are experiencing this issue and if so, how are you handling this situation?

We have patients that will present in our imaging centers for high tech imaging service and will ask to be registered as self. They are paying up front for their service. Afterwards, they will contact the billing dept and request that a claim be filed to their insurance.

Since they requested at the time of service to be self-pay, we are have completely for gone the prior auth process and now the claim is denying for no auth, patient not responsible.

Of course, once the patient gets their EOB they want their money back

As a contracted provider, are we "on the hook" for that service or can we still hold the patient responsible because they requested to be self-pay?

Do we have to file a claim to the payer at the patients request, even though they presented as Insured Self Pay? Seems like I remember once upon a time, patients could be reimbursed from a payer themselves- I am not sure if that's still a possibility...

Should we have the patient sign a waiver stating they understand they are self-pay for services rendered?

Thank you!

Kim Smiley, CPC, RCC (She/Her/Hers)

Coding Manager

ph:  (317) 328-7256  |  fax: (317) 715-9955

kim@northwestradiology.com

Hello,

I am curious to see if others are experiencing this issue and if so, how are you handling this situation?

We have patients that will present in our imaging centers for high tech imaging service and will ask to be registered as self. They are paying up front for their service. Afterwards, they will contact the billing dept and request that a claim be filed to their insurance.

Since they requested at the time of service to be self-pay, we are have completely for gone the prior auth process and now the claim is denying for no auth, patient not responsible.

Of course, once the patient gets their EOB they want their money back

As a contracted provider, are we "on the hook" for that service or can we still hold the patient responsible because they requested to be self-pay?

Do we have to file a claim to the payer at the patients request, even though they presented as Insured Self Pay? Seems like I remember once upon a time, patients could be reimbursed from a payer themselves- I am not sure if that's still a possibility...

Should we have the patient sign a waiver stating they understand they are self-pay for services rendered?

Thank you!

Kim Smiley, CPC, RCC (She/Her/Hers)

Coding Manager

ph:  (317) 328-7256  |  fax: (317) 715-9955

kim@northwestradiology.com