Managed Care Contract Negotiations
Aug 08

Get proof that member voluntarily authorized billing auto insurer

It’s a growing trend for providers to bill treatment of a member injured in an auto accident to the member’s auto insurer—before or instead of billing the member’s health plan.

Members may ask providers to bill the auto insurer under their “personal injury protection” (PIP) or “medical payments” coverage. Other times, providers suggest this, because they expect to get paid more and faster that way.

But whoever has the idea, there’s a hidden risk in billing the auto insurer before or instead of billing the member’s plan. Increasingly, members are pocketing the PIP payments rather than turning them over to providers.

If that happens to you, you could end up in an expensive and time-consuming payment dispute in which the member might claim that you inappropriately steered him or her to bill the auto insurer because you wanted a higher payment. And if the plan’s deadline for submitting a claim passes during your dispute, you might not get paid at all.

To help you protect against this risk, you need to be able to prove that the member voluntarily authorized you to bill his auto insurer before or instead of billing his plan.

Next week: Protect yourself with five steps to prove that a member’s decision to bill the auto insurer first was voluntary.

Editor’s note: This week’s tip was excerpted from HCPro’s monthly newsletter, Managed Care Contracting & Reimbursement Advisor. For more information, click here.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →