Insurance adjuster drops in for a visit...
This just in from a Client out East...
Good Morning!
I just had a GEICO insurance adjuster enter my office to have a tour and to take pictures of my office, equipment, license and diploma. Oh, and sign in sheets. She is investigating a claim of patient who was rear-ended and who's vehicle had little damage, but she had significant damage to her body. I allowed her to take pictures of my xray room and the exam room, but I had patients so none could be taken in the office. She also commented on what a nice office it was and my xray equipment was better than most she had seen. I quoted some research about rear -impact damage and how it can't be related to soft tissue/ structural damage in conversation.
She questioned a few things on my bill including an after hour charge ( I saw the patient on a Friday because she was hit on a Thursday night).
Any thoughts on how to handle that in the future? This is the first time that's ever happened.
My response...
First of all, I recommend not having sign in sheets. An NCR (carbonless two ply copy) fee ticket makes much more sense, as then there is no opportunity for anyone (such as an IRS agent or Insurance Adjuster) to obtain information about how busy you are. You can simply provide information relevant to the patient in question rather than your entire daily patient list. Also once they have those patients names, is it reasonable that they may want to subpoena other patients to testify what occurred routinely in the office when they were there? Bills and or charges to compare? They (adjusters) like to have information from sign in sheets so that they can compute your average time spent per patient to see if it jives with your charges. Get rid of the sign in sheet, order your fee tickets (I presented this at the Milwaukee seminar...(email me at drsjh@drscottheun.com for links to order.)
You could have refused the photos of the sign in sheet, and for that matter made the person schedule an appointment to come back at a more convenient time, when patients are not in the office, I HIGHLY recommend this practice in the future. Do not let them have free reign, you do not have to. Set the game up by YOUR rules...do not let them intimidate you, or show up unannounced.
Only answer questions that are asked, do not offer anything else...be cordial, yet firm, this is YOUR place of business. If you have a signed contract with an insurance company, you may find that you have to allow spontaneous visits...but if you DON'T have a contractual arrangement, this does not apply. They have no legal authority to come into your place of business and investigate in most instances. Being cooperative is important, but being a pushover is not.
I am not sure about the after hours charge, however it seems reasonable to me, you do not normally have hours at that time. However, that said, you may want to review the code on this point to see what the stipulations are exactly.
SJH
Good Morning!
I just had a GEICO insurance adjuster enter my office to have a tour and to take pictures of my office, equipment, license and diploma. Oh, and sign in sheets. She is investigating a claim of patient who was rear-ended and who's vehicle had little damage, but she had significant damage to her body. I allowed her to take pictures of my xray room and the exam room, but I had patients so none could be taken in the office. She also commented on what a nice office it was and my xray equipment was better than most she had seen. I quoted some research about rear -impact damage and how it can't be related to soft tissue/ structural damage in conversation.
She questioned a few things on my bill including an after hour charge ( I saw the patient on a Friday because she was hit on a Thursday night).
Any thoughts on how to handle that in the future? This is the first time that's ever happened.
My response...
First of all, I recommend not having sign in sheets. An NCR (carbonless two ply copy) fee ticket makes much more sense, as then there is no opportunity for anyone (such as an IRS agent or Insurance Adjuster) to obtain information about how busy you are. You can simply provide information relevant to the patient in question rather than your entire daily patient list. Also once they have those patients names, is it reasonable that they may want to subpoena other patients to testify what occurred routinely in the office when they were there? Bills and or charges to compare? They (adjusters) like to have information from sign in sheets so that they can compute your average time spent per patient to see if it jives with your charges. Get rid of the sign in sheet, order your fee tickets (I presented this at the Milwaukee seminar...(email me at drsjh@drscottheun.com for links to order.)
You could have refused the photos of the sign in sheet, and for that matter made the person schedule an appointment to come back at a more convenient time, when patients are not in the office, I HIGHLY recommend this practice in the future. Do not let them have free reign, you do not have to. Set the game up by YOUR rules...do not let them intimidate you, or show up unannounced.
Only answer questions that are asked, do not offer anything else...be cordial, yet firm, this is YOUR place of business. If you have a signed contract with an insurance company, you may find that you have to allow spontaneous visits...but if you DON'T have a contractual arrangement, this does not apply. They have no legal authority to come into your place of business and investigate in most instances. Being cooperative is important, but being a pushover is not.
I am not sure about the after hours charge, however it seems reasonable to me, you do not normally have hours at that time. However, that said, you may want to review the code on this point to see what the stipulations are exactly.
SJH
posted by Dr. Scott J. Heun at
7:53 AM
<< Home