Academy of Chiropractic

Quickie Podcast 1238
Office Systems 126 OS

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"How to determine if Med-Pay should pay me"


Dr Studin: Can you start from the beginning of what you just shared with me?

Guest Dr: So we're treating personal injury patients, they are coming to us. where any updated billing records to attorney's offices whenever requesting it. We're not aware when a patient is or has medpay and the attorneys are taking it upon themselves to bill directly to the medpay or to the insurance company and then they're getting a reimbursement and we're not knowing when reimburses are being made strictly to the attorney.

Dr Studin: What is your intake procedure with a new patient reguarding finances?

Guest Dr: We have to like their demographics, their accident details. We do have their own personal car insurance and there's the option for them to select if they have med pay coverage. But we just noticed patients are very weird about answering those questions.

Dr Studin: You have a significant breakdown in your system and the reason you're not getting paid as your fault. Not the lawyer's fault, they're just being a better business person than you are. When a patient calls my office and says, hi Dr studin, I'd like to come in and be a patient. My answer is were you in a car accident? Did you just slip and fall? What's going on? I was in a car accident, I'm sorry to hear that. Are you okay? No, I'm in a lot of pain. well then we have to get you in quickly. But what I'd like to do is take a little bit of information prior to you coming in so I can pre fill out your forms. That's the magic word, because who doesn't want their forms prefilled out? Who likes to sit in the doctor's office and fill stuff out? The answers No one. So this way what's in it for them is you're going to pre fill out their forms. name, address, phone number, occupation, email address, and also what kind of insurance do you have? Well I was in a car accident. Can you please get for me in the glove box of your car and I don't want him to put me on hold or call me back or I'll call you back in a half hour. I just need off that little insurance card, the name of your insurance company and the policy number, nothing else. And then what we're going to do is call the insurance company and we're going to make sure everything's in order so we don't have to surprise you with any bills, but I have a lawyer, not a problem. We'll contact the lawyer also once we have all our information together, patient's going to give you the information of their insurance card, you then call up the insurance company and you qualify the insurance and you say, is the patient a covered entity? Yes. Is their coverage still active? Yes. Is there a med pay provision? Yes or no? Is there a deductible, yes or no? Now you have all the information. What's the billing address? Now you have all the billing information. Now if listen to the last few podcasts you know about the irrevocable assignments.

Guest Dr: Yes, we have one of those in our intake ones already.

Dr Studin: And by the way, what I want you to do is go into the website section 15 of the forms of communication, assignments and rights. I just updated it yesterday. It's a brand new form and please download it and use it. So now what you have is in this form is a irrevocable assignment of benefits. And what irrevocable means is if you build a medpay and now the lawyer transfers the check to them. The key word is irrevocable, and they have that document. You have to send that in that assignment of rights and benefits and the insurance company now the insurance companies, but put on notices and irrevocable assignment, which was you can't revoke it when the lawyer sends information to redirect your med pay benefits. If the insurance company does that, you have to remind the insurance company, they have to send you a check and it's up to them to go after the lawyer to get the money back or the patient to get the money back because the patient already gave you an a irrevocable right. And now they have to send you a check and the lawyer can't redirect your money in a hold your money ransom for you to take less of a percentage of the money grab, butit's not the lawyers fault that they were a better business person than you right now they're doing a money grab.

Guest Dr: That makes perfect sense. And I'm completely on board with you. we do that part when the patients are coming to us. how would you recommend me talking to the attorneys? A lot of the patients that we do treat are coming straight over to us from the attorney's office.

Dr Studin: It works the same way. I need your insurance card.

Guest Dr: I completely understand that, but some patients are weird, I just want to know how would suggest I go about it with the attorney's office without taking them off?

Dr Studin: I don't care about taking the attorney off. what's your percentage of overhead? The average in this country is 50%. what's your percentage of overhead?

Guest Dr: right around 40 to 45% can I say there?

Dr Studin: So say it's at 45% that's before taxes, And they're going to give you $.50 cents on a dollar. So basically you're working for free and if you quadruple the number of client patients you get from these types of attorneys, you're going to go out of business. They need you, they need you in order to prevail. So I call the attorney and say, listen, I appreciate, I need to know what the medpay provisions are because please appreciate that med Pay us for medical payment My med pay. And I know there's only a certain limit on that and like I get all of those things, but I need to know what's available and I know you want to control that, but I'm going to go out of business if we don't get paid on a med pay we're just going to go out of business, and I'd be honest with the attorneys I'll work with you, But the other thing is, are you looking also at uninsured motorist and underinsured motorist?

Guest Dr: Yeah.

Dr Studin: that's great.

Guest Dr: the big concerns we're having right now we signed a reduction requests, in an insurance office and then, it went from basically $12,000 to $8,000.

Dr Studin: On this particular case?

Guest Dr: Yes. And then we got about a week later, we got med pay check for $9,600 did they had build in our name. So you've already trying to reduction requests.

Dr Studin: Did, did the check come in to you?

Guest Dr: Yes.

Dr Studin: With your name on it?

Guest Dr: Yes.

Dr Studin: So what I would do is say, listen, I appreciate the fact that I signed a reduction that's $8,000 and that's really about third party settlement. We got a direct med pay, nothing to do with the third party settlement. I'm releasing you from the third party settlement. It's no longer necessary for us to be involved in that. We've been paid. We're going to consider the med pay that we got as payment in full. And you're released from the balance. my patient's released from the balance period.

Guest Dr: What if they say They want us to send them the check ?

Dr Studin: I don’t know what you signed.

Guest Dr: we signed a reduction request saying that we're going to take the $8,000 off initially. Then we got the check. We didn't know that they had med pay and they and the insurance company sent us a check.

Dr Studin: did you took a reduction of your lien. But you know your lien is now zero. It's been payed.

Guest Dr: Okay. All right. we'll let them know that that was our big concern cause obviously we have a reduction.

Dr Studin: it was a reduction against, we have a $12,000 lien, We agreed to reduce our lien to $8,000 but our med pay check just came in for $9,000 and change of which we'll accept as payment in full and we won't be holding the patient responsible for the extra $2,600 whatever it is $2,900 were released from that in your cover, it's a numbers game and it's, it's a legal game.

Guest Dr: We were just noticing a lot more of the attorneys are taking the med pay and it's called a money rescue for reduction.

Dr Studin: It's a money grab.

Guest Dr: That's why I want to make sure that we don't do that anymore.

Dr Studin: I appreciate the lawyer's fight. It gets very expensive for them to deal with cases. They're all on contingency and then it's getting harder for everyone, but lawyers have to be battle lawyers and just fight at the right level to get paid more. That's all. That's not our job. And the better you get at what you do, the more the lawyer will want to work with you because you're the best solution for them to make money.

Guest Dr: So, if it's coming from an attorney's office, do they send that right to the insurance company, the irrevocable thing? So they get it first before we do?

Dr Studin: I don't know. I don't know what they send. I have to se it. make sure you control your paperwork in quickly, immediately. Like day one. You want to be in front of everyone else. Anything else?

Guest Dr: No, that's good. Thank you.

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