Billing

River Oaks Psychology

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WORKING ON CLAIMS

OUTSTANDING BALANCES

ADJUSTING FOR LATE-CANCELLATIONS / NO-SHOWS

EFT SETUPS

CHECKING EOB RECORDS

WEEKLY PAYROLL

FINANCIAL ACCOUNTING

Draft

Patients inquire about services in a number of ways, including but not limited to:

Calling or texting our main number 248-717-1232.

Emailing our general inbox hello@riveroakspsychology.com.

Emailing a specific staff member about services. When this occurs, the message should always be forwarded to our general inbox hello@riveroakspsychology.com because all new patient scheduling must be coordinated through our scheduling staff.

Sending a message through Psychology Today. Some of our providers have configured their Psychology Today settings to have their inquiries go directly to the inbox hello@riveroakspsychology.com. Other providers receive inquiries to their own email accounts, which they then forward to hello@riveroakspsychology.com.

Sending a message through social media. When this occurs, scheduling staff should direct the individual to send us an email at hello@riveroakspsychology.com with their insurance information.

WHY:  Importance of Ensuring the Provider is In-Network

Similarly, if you don’t verify that the provider is in-network with the patient’s health insurance, we run the risk of not receiving payment for the services. Claims will be rejected and left unpaid if the provider is not in-network with the insurance.

Although we have a spreadsheet in Google Drive which shows the insurance enrollments for each provider, the information on that spreadsheet should only be used as a guide for initially selecting a provider, and you still need to take the extra step to verify with Bell MedEx that the provider is, in fact, in-network with the insurance. 

Further, if Bell MedEx states that the provider is not in-network with the insurance but our records indicate that the provider should be in-network, you will need to verify the status of the provider with the credentialing department of Bell MedEx. Likewise, if Bell MedEx states that any provider is in-network but our records do not indicate this, you will need to verify the accurate status with the credentialing department of Bell MedEx.

Step 4 - Details

We provide the information to Bell MedEx (we submit a ticket to Bell MedEx).

River Oaks Psychology partners with a company called Bell MedEx to obtain coverage information for our patients. We use Bell MedEx to help us make phone calls to insurance companies because unfortunately there is not a simple way to “look up” coverage information for a patient online. Every insurance plan is different and not all insurance companies have an online portal where we can look up coverage details. There are a FEW insurances which do have an online portal, however the coverage details that are listed online do not state whether telehealth is covered. Further the information listed online is almost always unclear, ambiguous, and complicated to interpret. Therefore, it is impossible for us to look up coverage details for a patient online. There are too many variables and it’s too risky to trust the details that are listed online. The best way to get an estimate of coverage details is to call an insurance company directly and speak to a representative over the phone so they can verbally explain the coverage details and give you a reference number for the conversation. Sometimes it can take more than an hour for one of these phone calls. It is an extremely tedious, time-consuming process. 

Therefore, we rely on Bell MedEx to make these phone calls to insurance companies on our behalf.

We communicate with Bell MedEx through their secure, HIPAA-compliant ticket system called Docuhub. Docuhub is very basic and easy to use. It belongs to Bell MedEx (Bell MedEx created this software themselves) so if there are any glitches that are occurring within Docuhub, we report those to Bell MedEx directly.

Lauren is the admin user on Docuhub so she has a username and password to login and she sometimes submits tickets in her name. We also have a sub-user account which is what YOU will use to obtain coverage information for scheduling patients. The sub-user account is in the name River Oaks Assistant. Please note that all of your tickets will be visible by Lauren because the sub-user’s tickets are also copied into the dashboard of the admin user.

Here is the login page:

Sub-User Name:   River Oaks Assistant
Username:  river.oaks
Password:  Therapy100

Here is the dashboard page once you login:

Navigate to D-Mail on the left-hand menu. Click on View Tickets.

Carefully review how everything functions. 

How to submit a ticket

(to obtain coverage information):

If you have a picture of the patient’s insurance card(s), there is no need to type out all the details of the insurance. That will slow down your workflow and it is unnecessary. If you have a picture of the insurance card(s), simply write “Card(s) attached” in the body of the message and attach the image(s). Or you can also paste the image(s) into the body of the message if your web browser allows for that. 

Below is an example.

And if there is no policyholder, your ticket might look even more simplified, such as this example below. 

Step 5 - Details

We receive a response from Bell MedEx and we communicate the coverage details to the patient, also noting the important DISCLAIMER about insurance coverage, their financial responsibility, our late-cancellation and no-show policy, and also the importance of completing their intake paperwork prior to their appointment. 

If for some reason you don’t get a response from Bell MedEx within a few hours of submitting the ticket, please follow up on the ticket with a reply such as:   

  • Any update?
  • Still waiting on this.
  • I need an answer on this.
  • The patient is still waiting to be scheduled.
  • How should I respond to the patient?
  • I need a response ASAP.
  • Please respond.
  • What’s going on?

If for some reason you don’t get a response from Bell MedEx within 24 hours of submitting the ticket, please respond to the ticket asking for an explanation for the delay. No matter the reason for the delay, always follow up with the patient to explain that you’re having difficulties getting an estimate of their coverage information that you are actively working on it and you apologize for the delay. In the meantime, encourage the patient to call the number on the back of their insurance card to see if they have any success in determining their coverage details. 

HIGH quality patient service is extremely important to us at River Oaks Psychology.

We seek to treat every patient as if they are the most important person in the world. We have high expectations for ourselves and each other with regard to how we treat patients because our reputation depends on it.  River Oaks Psychology is known for going above and beyond, and we take that very seriously. Please review our core values on our website and make sure that you are corresponding with all patients in a manner that aligns with our company culture. 

If there is any delay for getting a patient scheduled, please apologize to the patient and actively work to expedite the process however you can. If you get stuck, please contact Lauren for help. 

Interpreting responses from Bell MedEx.

Bell MedEx employs international workers. Not all of them are overseas, but many of them are, especially the ones that will be responsible for calling insurance companies to verify coverage information. We have had extremely positive experiences with the dedication and work ethic of these employees and we greatly appreciate their fast-paced work style with their careful attention to details. Although English is their second language, these records are generally extremely attentive to details, they are very hard workers, and they are committed to customer service. When we have issues, they have quickly resolved problems and they do a fantastic job helping River Oaks Psychology with all of our insurance needs. 

With that being said, sometimes there are grammatical errors in the responses that we received from them. Please be extremely careful when interpreting their responses. You will get better at this over time. In the beginning, if you ever have questions or are not sure about something, please ask Lauren for clarification. 

Below are several examples. 

Example Response:

Collect $172.97 for CPT 90791 and $145.87 for CPT 90837.

What it means:

You need to tell the patient that their insurance has told us the first appointment will be $172.97 and each following appointment will be $145.87. Do not state the billing codes to the patient. That will confuse them. Just remember that a 90791 is an intake appointment and a 90837 is a standard appointment for individual therapy. These amounts will be collected on their credit card at the time of each appointment. You might also want to remind the patient that we do not set these rates and we have no control over them. We are just contracted to follow these rates that are set by their insurance provider. Please also encourage the patient also to call their insurance provider directly and verify that these details are accurate (if they have not already done so). Again, remind the patient that this is an estimate of what they will owe for services based on what their insurance provider has told us. After the claims are processed, we will reconcile any differences. 

Example Response:

Benefits have been verified. Client have PPO plan effected from 01/01/2020 patient Deductible 3800/ 2703.05remaining once deductible met patient responsibility is 10%coins. POS 10 would be used for Telehealth services. Collect $172.97 for CPT 90791 and 145.87for CPT 90837.

What it means:

You need to tell the patient that their insurance has told us the first appointment will be $172.97 and each following appointment will be $145.87. In this case, you can also tell them that once their deductible has been met, they will only need to pay a 10% coinsurance, which means 10% of the rates. If they ask you for clarification on what that means, please explain to them that once their deductible has been met, they will only need to pay an estimated $14.56 for standard appointments. You could have figured this out by looking at the contracted rate for a 90837 (145.87) and calculating 10% of that. 

People don’t want to hear that they have to pay a large amount until their deductible is met. So it’s helpful to remind the patient that once their deductible is met, the amount that they will pay at the time of each appointment will be less. Please always remember to empathize with people regarding insurance barriers and frustrations, and reframe the situation to be more positive. 

For example, “We totally understand how frustrating insurance can be! Mental health is so important and we wish that your insurance would cover therapy completely for you! Trust me, if we can get your insurance to cover all of your services, we absolutely would! We hate insurance just as much as you do. But the good news is that once your deductible is met, you will just over 10% of the cost!”

Example Response:

Benefits have been verified. Client have PPO plan effected from 01/01/2022 patient current responsibility is $50 copay and provider is in-network. POS 10 would be used for Telehealth services.

What it means:

You need to tell the patient that they just have a co-pay of $50 per appointment. Remind them that this will be collected on their credit card at the time of each appointment. 

Example Response:

Benefits have been verified. Effected from 04/01/2022 this is Medicaid plan and insurance will covered 100% also provider is in-network.

What it means:

You need to tell the patient that they do not owe anything out of pocket for services because they have 100% coverage! You also need to tell them that they do not need to upload a credit card to the client portal because they have Medicaid and we do not require a credit card from any patient who has Medicaid insurance. Even if the patient has a secondary insurance of Medicaid but a commercial primary insurance, we still do not require a credit card on file because they are considered a Medicaid patient even if Medicaid is only their secondary insurance. Whenever Medicaid is involved, whether it’s primary or secondary, the patient will not owe anything for services. 

Example Response:

Benefits has been verified. Client Primary insurances BCBS of MI effective from 01/01/2021 and Secondary insurances Medicaid, So secondary insurance will covered the Primary left over.

What it means:

You need to tell the patient that they do not owe anything out of pocket for services because they have 100% coverage! They have Medicaid so no credit card is required on file. Please explain to the patient that they may receive paperwork from their primary insurance in the mail that states they owe money for services, however because they have a secondary insurance that will pick up whatever the primary insurance doesn’t pay, they do not need to worry about any bills for services.  Please explain that we are going to be billing their primary insurance and then once each claim is processed by the primary insurance, we will then proceed to bill their secondary insurance to pick up whatever their primary insurance doesn’t pay. The bottom line is that you need to tell them they don’t need to pay anything for services. If they have questions about billing, they can contact Lauren.

TRICKY Response:

Called to insurance S/W nick r Rep no#9172 he told us that member Michigan Medicaid policy is out of network with River Oaks Psychology.

What it means:

Any time that you see the words out of network, that’s a problem. The patient will not have any insurance coverage and you need to see if the patient is willing to pay privately for services. If we are out of network as a practice as a whole, or if the specific provider on staff who the patient will receive services from is out of network, the only option is to have the patient pay privately for services. Every provider has a different private pay rate so you need to check with the provider to see what rate they want to use for the private pay case. Make yourself a cheat sheet to keep track of what each provider wants to use for their private pay rate. For all private pay cases, you have to configure the billing settings in a specific way for private pay patients. 

TRICKY Response:

 Rep told that Mental Health Benefits are carved out to Beacon Health and RIVER OAKS PSYCHOLOGY is OON with Beacon Health,

What it means:

Any time that you see the words “carved out” that means the insurance coverage is being funded by a different entity than what is stated on the card. These are tricky cases because a patient may give you a card that says Blue Cross Blue Shield on it. It may look exactly like a Blue Cross Blue Shield card. However, the actual benefits are carved out to Beacon in this example here. This is a great example of why you can never schedule a patient without verifying benefits with Bell MedEx. You may receive an insurance card and think that it looks legitimately like an insurance that we are in network with, but you can never trust what it says on the insurance card. Sometimes the benefits are carved out to a different insurance provider. Again, we cannot emphasize enough how important it is to always verify insurance with Bell MedEx prior to scheduling a first appointment. 

TRICKY Response:

Benefits have been verified. Client have HMO plan effected from 04/01/2020 deductible2800/2,382.31remaining once deductible met insurance will covered 100% also provider is in-network. POS 10 would be used for Telehealth services.

What it means:

If you aren’t being extremely careful, you may read this response and think the patient has 100% coverage. You may quickly see the words that say  “insurance will covered 100%” and you may be thinking that that means the patient has 100% coverage.  WRONG!  If you reread this response carefully, you’ll see that they are stating that the patient will have 100% coverage only after the deductible has been met. So what is the patient going to have to pay per appointment prior to the deductible being met? In this example, they forgot to tell you. So you need to reply to this ticket and ask them for the amounts that the patient will have to pay per appointment. You can’t respond to the patient until you have that information. 

Insurance is very tricky and you will be faced with many responses that may be challenging to interpret. However, you will get better at this over time.

  • Never make assumptions.
  • Ask for clarification when needed.
  • ASK LAUREN IF YOU GET STUCK!
  • If you’re even slightly unsure, please ask.
  • If something seems inconsistent with the response you expected, please follow up with Bell MedEx and ask for the benefits to be re-verified.

If the patient believes that their coverage is different than what Bell MedEx has found upon calling their insurance, please ask Bell MedEx to reverify the benefits. It’s very possible that the insurance representative over the phone gave the wrong information. 

Unfortunately, insurance representatives are not always accurate. Nonetheless, calling insurance representatives over the phone is the best way to find out details of coverage. Sometimes we have to re-verify multiple times though.