14 I Fall 2018 www.anjc.info SAFEGUARDING YOUR REIMBURSEMENTS By Heather M. Garcia As we all know, insurance rules are changing daily, leaving some guess as to what new rules we have to learn today. But what happens when a new rule affects your checks coming directly to your office? How can you safeguard your insurance checks to make sure the checks get sent directly to your office and not a patient? Furthermore, what do you do if a patient receives a check? This is all too familiar these days, and whether you are in or out of network it can happen to you. While nothing is ever foolproof, you can take steps to safeguard your reimbursements: 1) All providers should have all patients sign a form stating that if the patient receives a check they will send it to the office within a certain time frame. Do not pick and choose who signs this form. It should be a standard form given to all patients. Picking and choosing leaves you open to not having it on any given patient when it is needed. It’s better to have the form signed and never use it than not to have it at all. I have supplied a sample form below. You should always consult your health- care attorney before utilizing any forms within your practice. Re: Professional Fees I, _________________________________, am aware that my insurance company may send me payments for services rendered by Provider’s Name and/or Practice Name, which includes Type of Services. I agree that when I receive any payments from those services, I will: 1. Sign/Endorse the check, and I WILL NOT DEPOSIT or CASH it. 2. Under my signature, I will print the following: “Make Payable Only to Practice Name” 3. I will enclose the check with accom- panying letters or forms, such as the Explanation of Benefits, in an envelope, and mail immediately to Practice Name at the address on this letterhead. Or bring to the office within 5 Business days from receipt of the checks. I also understand that in the event the check is not immediately sent to Practice Name, I will be responsible to pay the full and entire fee for all services rendered, plus any additional collection fees and legal costs in connection with collecting this debt. I will be provided a copy of this letter as a reminder as to what is required of me when I receive the payment from my insurance company. By signing below you are stating you understand the conditions of receiving treatment at Practice Name and will comply with all the terms above or will be liable for all bills. _________________________________ Patient’s Signature Date: ____________________________ Witness: _________________________ Date: ____________________________ 2) Always try to have a patient’s Social Security number on file. I know nowa- days patients are not always willing to give their Social Security numbers to the office, but you should try and get the number from the patient. It will help you if you need to take steps in collecting your professional fees directly from the patient. If you know that this is an insurance company that sends checks to patients, I would insist on getting a Social Security number to safeguard your office. 3) When sending in your claims to insurance companies, make sure you have Box 27 on your CMS 1500 forms checked off. This says that you accept assignment, which means you have an assignment of benefits (AOB) on file that the patient has signed. I have supplied a sample form below. You should always consult your health- care attorney before utilizing any forms within your practice. Assignment of Benefits and Authorization While (Practice Name) is waiting for payment for all of the fees, I agree to provide the office with information and forms regarding any source of potential payment, to assist in any way I can, and: 1. I hereby assign (Practice Name) my rights to receive payments from the insurance companies responsible for my claim. 2. I also hereby authorize the direct payment to (Practice Name) of any sum I now or hereafter owe by any insurance company obligated to make payment to me or you based in whole or in part upon the charges made for your services. 3. You are authorized to release any information including the diagnosis and records of any such treatment to any insurance company to process any claims for reimbursement of charges incurred. 4. I hereby assign and transfer to you the cause of action that exists in my favor, including the right to proceed via state external appeal or Superior Court, against the insurance company, responsible for this claim to collect any unpaid bills. THIS IS A DIRECT ASSIGNMENT OF MY RIGHTS AND BENEFITS UNDER THIS POLICY. _________________________________ Patient’s Signature Date: ____________________________ 4) Most major medical claims go electronic these days but if you know it is a payer that sends checks to patients, or it is a workers comp or PIP claim then you may want to submit your claims