Office Systems #24
Quickie Consult #565
Office Systems 40 OS

From the Desk of :

“Get Paid and Avoid Law Suits & Audits”

There is a reason my doctors get paid so much higher and get to both keep their money and sleep at night…..

I received this yesterday: 

I picked up the fee schedule text you recommended and here's the response I wrote up to send to the auto carriers denying full payment, stating that our fees are too high.  Would you change anything? Or does it look okay to send?

This is my amended response: 

Our fees are derived directly from the 2015 Practice Management Information Corporation (PMIC) Text, “Medical Fees – A Comprehensive Listing of Current UCR and Medicare Fees with Relative Value Units.”  We utilize the weighted averages established by the CMS report, “Review of Alternative GPCI Payment Locality Structures – Final Report”, published in 2010 for our geographic location.  Our services/fees are billed at the UCR 90th percentile or less, therefore, your denial of our full payment for services rendered is unsubstantiated. We utilize UCR (Usual, Customary and Reasonable) rates for our region and it is against the law to discriminate against provider type.Payment is now demanded in full with interest as per the Colorado Statute below: 

As per Colorado Revised Statute: 10-16-106.5- Prompt Payment of claims:

The carrier must settle all claims, other than clean claims, within 90 days after receipt. • A carrier that does not settle a clean claim within 30/45 days; contact you for additional information within 30 days; or settle any other claim within 90 days shall pay the physician (or patient if you are not participating with the plan) interest at the rate of 10% annually on the total allowed amount, accruing from the date the payment was due… • A carrier that fails to pay, deny or settle a claim within 90 days after receipt shall pay an additional penalty of 10% of the total amount allowed. • If the carrier does not pay the penalties with the claim, they may aggregate the penalties for the provider and pay on a quarterly basis or when the amount owed exceeds ten dollars. • If a carrier delegates the claims processing function to another entity, such as a physician organization (e.g., PMG, POD), the delegation agreement shall require that the entity comply with these same timely processing standards. • The law applies to fully insured health insurance plans in the state of Colorado.

(Note:  CMS = Centers for Medicare and Medicaid Services, GPCI = Geographic Price Cost Index)



Adjunct Assistant Professor of Chiropractic, University of Bridgeport, College of Chiropractic

Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College

Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences 

Academy of Chiropractic 

US Chiropractic Directory

Click to view Dr. Studin's CV 

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