What is medical billing and coding?
When a patient has any medical exam or procedure, the medical office will work with the patient and the patient's insurance company for claims. The biller will submit and follow up on any claims to receive payment for services rendered by the health care provider. This usually involves learning many codes, each one representing a symptom, medications, and diagnosis, in order to process the claim properly. Medical billing and coding workers are the health care professionals in charge of processing patient data such as treatment records and related insurance information. Medical insurance billers and coders are tasked with coding a patient's diagnosis along with a request for payments from the patient's insurance company.
To speak with a billing specialist at the Foot and Ankle Center of Nebraska and Iowa, please call 402-391-7575 option 5.
What payment method's do you accept?
We accept most insurance plans and are a preferred or Tier 1 provider for many Blue Cross/Blue Shield, United Health Care, Coventry, Aetna, and Humana plans. We also take checks, cash, and major credit cards. If a payment plan is necessary we offer CareCredit service to our patients.
What is the billing process like?
The process starts at your doctor’s visit. The physician evaluates your condition and renders treatment. Three primary types of service can be provided: an office visit, a procedure, and/or durable medical equipment. Each new patient will have a new patient office charge. This is universal in healthcare as a patient is established in an office. This charge cannot be used again unless the patient has had a three-year gap in services. Follow office visits may be charged. Procedures are codes for any physical treatment provided. This can include removing ingrown toenails, trimming calluses, or performing major surgery. The final charge is durable medical equipment or DME. These charges are for medical supplies such as a brace, bandage, or crutches.
After the visit, the charges are processed by billing and sent to your insurance company. They process the claim and will do one of three things: pay the claim, deny the claim stating that the payment is your responsibility (uncovered service) or deny the claim and request more information. This part of the process can take months or even years. This is also where many patients can get confused or frustrated due to the excessive delays in the system.
After the claim is processed, our billing team then sends out statements for any balance due. Mailings from our billing department will follow the following flow:
|0 to 30 days past due||Statement issued|
|31 to 60 days past due||Statement issued|
|61 to 90 days past due||Statement issued|
|91 to 120 days past due||Demand letter sent|
|121+ days past due||Balance sent to Third Party Collection Agency|
Our Third Party Collection Agency, unless otherwise prohibited by law, is authorized to contact patients 1) by telephone at the telephone number(s) provided to our office and registered to the patient’s account including via wireless telephone numbers, 2) by sending text messages or emails, 3) using prerecorded/artificial voice message or automatic daily services. The message, phone, and/or data charges may apply.
Who determines the amount paid on office and procedural charges?
Health care payments are determined by contracts with insurance carriers. Government plans such as Medicare and Medicaid have set fee schedules for services and medical goods that we provide. These fee schedules are not negotiable and are determined on a state and national scale. Commercial carriers have negotiated contractual rates. These rates can vary even within the same commercial carrier based on your plan. The value of a procedure or service is based on three factors: physician work (54%), practice expense (41%), and malpractice expense (5%)
Can I negotiate my bill or do you provide discounts for prompt payment?
While many physician offices and hospitals may reduce the amount you owe, we do not. The amount that you owe is based on your insurance benefits. Reducing that amount by waiving co-pays and reducing deductibles collections, is illegal and is considered insurance fraud. If this occurs and you have government plans such as Medicare or Medicaid, reducing payment violates both the Stark law and Anti-Kick Back statutes. If you are under an employer's benefit plan, this violates the ERISA act. The only exception to these laws is if we can prove financial hardship. Please refer to the section “Financial Hardship Program” to further details.
Can I set up a payment plan on my balance?
Under certain circumstances, we will allow payment plans for outstanding balances. We attempt to arrange manageable payment plans for our patients who need further financial assistance but do not qualify for the “Financial Hardship" program. We require a credit card on file to arrange a payment plan. Payment will be charged to the card if your payment has not been received through other means prior to your due date. You may also qualify for Care Credit, a specialized medical credit card that has various repayment options. We are proud to offer alternative payment methods to ensure our patients have access to the care that is needed. Interest and fees may apply if you choose to use our Care Credit plans.
What is CareCredit*?
For almost 30 years, CareCredit has been providing financing options for treatments and procedures that typically are not covered by insurance or for times when insurance does not cover the full amount. CareCredit is also used by cardholders to pay deductibles and co-payments. For more information see the CareCredit website.
*Subject to credit approval. Minimum monthly payments are required. Interest in balance and fees may apply.
How do I apply for CareCredit?
You can apply for CareCredit online or can call 1-800-677-0718.
How can I pay with CareCredit?
To make a payment with CareCredit, you can use the CareCredit portal (https://www.carecreditprovidercenter.com/portal/login) or by stopping at one of our office locations. Payments cannot be taken over the phone.
Financial Hardship Program
Patients with balances due resulting from limited or no insurance coverage may qualify for our Financial Hardship Program. This application is appropriate for patients who meet the financial eligibility rules and have no insurance remaining balances due following the payment by the insurance carrier. We use the current poverty income guidelines issued by the US Department of Health and Human Services to determine a person's eligibility for indigent care. Full or partial eligibility is determined by documented family income and family size. The patient is responsible for providing the information requested during the qualification process. A determination letter will be mailed to you after receipt of the fully completed application and requested supporting documentation. If you have been approved, you should contact one of our Billing Specialists. Once approved, a billing specialist will work to create a repayment option that may include a payment plan and/or balanced adjustments. This will occur to all current charges and future charges up to 30 days from the application date. If further care is necessary outside of 30days from approval, a second application will be necessary. You can download the Financial Hardship application here.
For more frequently asked questions or information on our billing policies, you can download our education brochure on medical billing or contact our billing department.