Welcome 2022! Another year of shifting gears, creating new systems, and finding new ways to do our jobs.
What are we hearing and seeing? It seems like every day I come across comments about how frustrating the customer service has been at the insurance carriers. Trying to get a customer service Rep on the line is nearly impossible. With so many people working remotely in the insurance industry we are seeing a large impact with regard to response time, overall customer service skills, as well as with their knowledge about what exactly is happening. We seem have no choice but to use the online portals to get benefit and claim information. If you have been resistant to signing up for the portals, I strongly suggest and encourage you to do so in order to find out as much as you can online before you pick up the phone. The good news is that there has been much improvement with the online portals. So, save yourself some time and sign up for as many as possible.
What else did 2022 bring us? Well, in case you missed it, as of January 1st the federal Surprise Billing Act was implemented. What does this mean for you? For patients receiving services at in network facilities (i.e. hospitals) by an out of network provider, unless the patient was notified in advance and had a choice of providers, then the patient can only be held to in network fees. There will be a negotiation between the out of network provider and the insurance carrier and the patient cannot be balance billed up to your full fee. So, if your office takes calls at the hospital, make sure you read up on this new law, because it will impact you. You can find more information about it here.
We have also seen some states pass similar laws which may be more restrictive and include office-based procedures. A written estimate will need to be provided to patients notifying them of their total expected out to network costs. If the notification was not provided, you may not be able to balance bill your patients. Check your state laws and see if this applies to you.
A good practice is to check insurance benefits for patients, notify them in advance if you are an out of network provider, and make sure you are transparent with your fees. Best practice is to have patients sign treatment plans so you have proof the fees were discussed with them.
Another reminder for 2022..make sure you have updated your software with the new and updated CPT and CDT codes. While you are gathering information, reach out to the carriers you are in network with and obtain the updated 2022 fee schedule so you have correct information to share with your team and your patients.
Later on we’ll share some upcoming information for changes to Medicare Advantage plans for opted out providers.
Until next time, Keep Calm and Code On!
TERRI
