In a previous post, I wrote about the growing payment problem known as “Virtual Credit Cards” that payers are in love with and providers are…well, in hate with. Today, we I’d like to warn you about yet another way payers are attempting to rob you of your hard earned money.
Many of you have probably received a letter similar to the one pictured below offering you “expedited” handling of the reimbursement owed on an outstanding claim. I’ve written about this before and as frustrating as it is, this scam is STILL being used by a number of different companies who contract with payers to primarily (but not exclusively) target out-of-network providers and personal injury claims (for whom you are obviously also out of network). These letters, which are often received by fax, propose to “expedite payment and decrease the patient’s responsibility.”
While this sounds admirable in theory, a quick look at the math behind this proposal will illustrate why you should feed such documents to a hungry shredder as quickly as possible. Look at the example below:
Billed charges were $320 and the proposed expedited reimbursement is $198.40 which represents a 38% discount from the billed fee. This much is clear; you will be paid much less. Their proposal is that you will receive payment within 10 business days in exchange for your willingness to take a huge hit on your fee.
Presuming that this 10 business day window for you to receive payment would be accurate, that means that you will receive payment in about 12 days. In reality, billing industry averages indicate the electronic billing typically produces a check in 15 days. So, by participating in such an Agreement you have accepted a discount of 19% per day (approximately $60 per day) for this expedited handling. Ouch — that’s some unfavorable math!
Bad Math, Worse News
It gets worse. In addition to the bad math illustrated above, the fine print of these Agreements typically state that “this is not a guarantee of payment.” In other words, they can delay your claim anyway, despite the fact that you signed the “expedited” agreement claiming medical necessity, notes required, pretty much anything. Worse still, you agreed to the discount — even if the payment is late.
To really heap on the insults, the Agreement states that “your signature below indicates your acceptance of the Expedited Price and your agreement not to bill the patient for the difference between the billed charges and the Expedited Price.”
What the agreement fails to stipulate is what legal rights you have if the company fails to pay you in the 10 day time period, as agreed. And yes, you guessed it – even after you sign the agreement, these payments rarely arrive on time and you, of course, have no recourse.
Bad News AFTER Signing
Not to kick you when you’re down, but perhaps to further drive home my point, we’ve received emails, calls and listened to angry chiropractors and their billing staff who — unaware of these scams — signed the expedited agreement and…waited, waited and waited some more for their (reduced) payment to arrive. Yes, I know you can see where this is going because YOU I am sure are smarter than the average bear. You got it — even AFTER signing, the payments arrived in the same old slow fashion. In other words, the “expedited” agreement did nothing. Oh bother!
More Billing Shenanigans
Certainly, this is not the only type of subversive game that insurance companies and their cohorts like to play at your expense. Many of you wonder what to do when an insurance company decides to discount your fees “due to your participation in our network.”
A quick look at your contracts will reveal that you never signed anything to be a part of this network and, in fact, you don’t even know what the terms of the network are. Without even knowing who is trying to foist this upon you, I can tell you this: the terms stink and the network is probably bogus.
This phenomenon is called a “Silent PPO” and is popular technique used among Chiropractic Personal Injury insurance carriers to reduce your fee due to your imaginary in-network status. Fight this nonsense and appeal for full payment. (This appeal letter and dozens of others like it are part of my Chiropractic Appeals Toolkit).
Tax ID Requests and W-9’s that Pack a Wallop
Another slight-of-hand trick that is waged at chiropractors is the request for taxpayer information. Obviously, many of these are legitimate but they need to be handled carefully. Recently a client showed me a fax asking for “current taxpayer info” that looked innocently enough as a simple request for updated info. A closer look revealed that by providing the tax info and his signature, the provider had signed his way into a network that agreed to discount all of his services by 75% of allowed amounts! Of course this network had no members that it would send over as new patients; it was simply a third-party administrative network that handled PI claims. In other words, instead of receiving 100% reimbursement for his PI work, this provider signed up for a 25% discount in exchange for…nothing!
Be on Guard!
I could go on with a dozen other examples of the various scammers that attack our profession from every angle. The bottom line is: be very careful. Do not sign any agreements that you do not truly understand. Beware networks you have never heard of. And be very leary of any such proposals received only by fax. Most legitimate requests by payers, Medicare or any other entity are all going to be handled by mail, not via a medium such as fax or email which is commonly accessed by spammers and other con artists to send 1000s of scams at the touch of a button, with no cost involved to them.
Looking to improve your Chiropractic Personal Injury practice? Consider attending one of our upcoming Chiropractic Personal Injury POWER Seminars where you will learn how to RAPIDLY improve your MVA coding, documentation, case management, billing and business strategies for a bigger, better, more profitable PI practice! Click the link above for more details and to register.