Ask the Experts Answer: Urgent Care Center
Q: We are opening an urgent care center that will be hospital-based. The consulting team that is setting-up the billing suggests that we have two different charge slips and two different prices -- one for self pay and one for insurance patients. I am not comfortable with this recommendation and would like guidance on charging two different prices.
Ask the Experts Answer: Provider Refunds for Insured Patients
Q: Do you know of any policy/legislation or general practices regarding a provider refunding a payer if the patient was authorized but then later found by the payer to be uncovered because they are secondary?
Ask the Experts Answer: Industry Standard Off-Billed Charge
We are a niche DME provider trying to set a patient pay rate for those who are either under insured, don’t have insurance or are out-of-network. What would an industry standard discount off-billed charge look like for those without benefits and when we don’t incur the cost to bill the third party?
Ask the Expert: CMS Statements for Medicare Patients
States--not CMS--have regulations in place related to timely patient notification of the availability of financial assistance/charity, as well as a statement that includes a summary of charges.
Ask the Expert: Patient Price Estimation
Advice for revenue cycle leaders on HFMA and online resources for determining patient price estimation.
Managed Care Ask the Expert Answer – Robotic Surgery
Q Are commercial payers paying for additional charges billed by hospitals for robotic surgery? At least one payer that pays on a % of charges basis is not paying the charges for the robotic surgery, additional OR time, etc. and
Managed Care Ask the Expert Answer – Payer Report Card
Q We are beginning to develop a Payer Report Card and instead of "creating the wheel" do you have a report card that you have already developed that you would be willing to share with us? A Similar to your
Ask the Expert Answer: Fiscal Intermediary and Medicare Bad Debt
Q Our FI is currently disallowing our Medicare bad debts which we claimed and wrote off in accordance with our charity care policy. We believe our Medicare deductible copay amounts that we did not collect because the patient was indigent
Ask the Experts – Medicare Payment
Dale BakerDale E. Baker is the President of Baker Healthcare Consulting, Inc. (BHC), an Indianapolis based consulting firm serving over 1,000 acute care hospital clients in forty four states since 1990. BHC specializes in advising clients on Medicare geographic reclassification
Ask the Expert: Hourly Documentation for Observation Status
Q "At one point, I heard rumors that CMS was going to require hourly documentation by nursing to support Observation status. I feel as if this did not go forward, but have no hard documentation that it remains at every