Financial Policy & Procedures
This notice outlines the financial policies and procedures of The Back Alley Chiropractic & Massage. Please review it carefully. Contact our office with any questions (520) 877-2666.
Patient Billing Protocol
While our standard office policy is to require payment at the time of service, there are times when insurance companies must be billed in advance of collecting payment from the patient. In addition, errors can happen during the verification process that may leave a patient with a balance or a credit.
Why do we have a Patient Billing Protocol? We have created this policy to establish a non-discriminatory procedure for our patients.
How do we bill patients? Patient billing is an on-site office process, with patient bills printed on paper, and mailed at 30-day intervals.
What happens to delinquent accounts? Our office utilizes an outside collection agency for patient accounts that are uncollectible.
What happens if a patient has a credit? A credit will remain on a patient’s account until it is either refunded or applied to future dates of service. A patient with a credit may request a refund of said credit at any time, by telephone or mail.
Patient Billing Procedure:
- Patient billing is processed every 30 days at approximately the 15th day of the month
- Unpaid balances are past due at 30 days of EOB/835 processing
- The patient will receive a FIRST notice indicating the balance due is copay, deductible, or explanation of other reason
- The patient will receive a SECOND notice if balance is left unpaid at the next billing cycle
- The patient will receive a third and FINAL notice to remit payment within 10 days, if balance is left unpaid at the next billing cycle
- If a balance is left unpaid after FINAL notice, the patient is referred to our collection agency for further collection activity
We do not write-off any charges as a standard procedure. Uncollectable accounts should be referred to our collection agency for further collection activity. Samples of acceptable write-offs:
- Allowed amounts by contractual obligation
- Timely filing by contractual obligation
- Medicare QMB eligible members are not responsible for deductible, coinsurance, or copay. This eligibility is verified during the verification process.
- Hardship cases. This eligibility is determined through application process.
Claims Billing Protocol
Claims billing is a process that begins at the Front Desk, with proper collection of information and data entry. It is equally important to collect the information as it is to verify the information received before the patient is rendered payable services. Benefits should NEVER be guessed at.
Why do we have a billing protocol? For our biller to properly submit claims, we must be sure data is entered timely as well as accurately. We must also be sure that patient insurance policies are verified properly.
Who is our biller? At this time we handle all billing in house.
How are claims submitted? We submit claims electronically through a clearinghouse.
How do we verify benefits? Our office utilizes an all in one online access to verify most insurance policies, including Medicare and AHCCCS (Medicaid), as well as many supplemental policies. When necessary, we can utilize online provider portals or provider services by telephone.
Claims Billing Procedure:
- Patient provides identification and insurance information to our office
- Staff contacts insurance company to verify Eligibility and Benefits
- Services are rendered at the time of patient’s appointment
- After services are rendered, the provider identifies CPT codes and ICD-10 codes for diagnosis
- Office Staff enters patient’s data and demographics
- Demographics must include patient’s full name, address, phone number, date of birth, and policy holder full name, address, phone number, date of birth and employer. IT IS IMPERATIVE this info is entered accurately to avoid claim denials.
- Other data that is required includes ICD-10 diagnosis codes, onset date for Medicare policies, insurance policy information, and CPT codes for services rendered
- The biller creates insurance claims using the patient’s data. The biller then converts the claim into an electronic file that is submitted to the clearinghouse, which then forwards the claim to the insurance company.
- The insurance company processes the claim and either accepts it or rejects it. The insurance company sends the status decision to the clearinghouse. If the claim is valid, the insurance company will reimburse for services based on network status contracted rates. If the claim is rejected, the insurance company will provide the clearinghouse with a detailed description of why the claim was denied.
- Rejected claims must be promptly corrected and refiled so that timely filing limits are adhered to.
- EOBs and ERAs should be processed timely so that AR records and patient ledgers are continually up to date
- Following the processing of EOBs and ERAs, the patient should be billed for any outstanding balances. Likewise, credits may be refunded by check if requested by patient (see patient billing protocol for more information).
Payment We accept cash, check, and debit, Visa, MasterCard and Discover. There is a minimum fee of $25 charged for returned checks.
Insured By request, as a courtesy to our patients, we will submit your medical claim to your insurance carrier. Patient balances are billed immediately upon receipt of your carriers EOB. Your remittance is due immediately upon receipt of our bill.
Self-Pay We offer a pay-at-time-of-service discount for all patients. If you fail to provide payment at the time services are rendered, you will be responsible for and billed for 100% of the professional fee.
Delinquent Accounts Unpaid balances are past due at 30 days. Balances left unpaid may receive a second and third notice prior to final notice, mailed at 30-day intervals. The Back Alley utilizes an outside collection agency. Balances over 120 days past due may be submitted to our collection agency.
Medicare We accept Medicare assignment. As a Medicare patient you are responsible for your deductible and co-insurance. If you have secondary or supplemental insurance we will bill it for you. Medicare non-covered services are due at the time of service.
Workers Compensation If you are here as a result of a work related injury; we will require information regarding your health insurance and your employers Workers Compensation insurance.
Personal Injury Claims We bill third party insurance carriers only on a lien basis. Please notify our staff of your personal injury immediately. You will be asked to complete forms specific to personal injury as well as a consent and notice for medical lien.