Billing For Services
In this month's newsletter we looked a two more issues Athletic Trainers have asked about: Co-pays/Deductibles and Billing for Physicals.
Insurance companies use co-pays and deductibles as a mechanism to discourage insurance over-use. Policy premiums are established based on these amounts being borne by the patient. The question has come-up of can a school waive co-pays or deductibles, sometimes called "fee forgiveness". A search of the web shows an increase in insurance companies investigating this practice. The following article provides a good overview of the issues involved.
While the article is titled out-of-network, it also includes references to in-network billing in the last paragraph.
"Finally, whereas the waiver of patient cost-sharing responsibilities by providers often arises in the context of out-of-network services, it is important to note that such waivers can have similar, if not harsher, consequences when done in relation to both in-network services..."
Billing For Physicals:
Many sports programs perform pre-season physical screenings for athletes, with some billing for those services. If you intend to bill for physicals, it is important to know that an annual physical and a sports physical are not the same thing; an annual physical must meet certain standards in order to qualify for reimbursement under the ACA. The physical must be conducted under doctor supervision and must include comprehensive medical history, physical exam findings, notes on ongoing or chronic issues and any “age-appropriate” notes and tests.