Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Your reputation is more important than your paycheck, and your integrity is worth more than your career.” — Ryan Freitas, About.me co-founder
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Nature does not hurry, yet everything is accomplished.” Lao Tzu
Here is another book the Team at Callagy Law recommends!
START by Jon Acuff.
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Do not fear mistakes. You will know failure. Continue to reach out. ” Benjamin Franklin
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“I’d rather have one percent of the efforts of 100 people than 100 percent of my own efforts.”– J. Paul Getty
Today was a fun day at Callagy Law! When you give our staff a few freebies, we go a little crazy on social media!
We wanted to share a bit of our fun, and hope you enjoy!
Medical doctors enter medicine to practice medicine, not to be bill collectors, but running a medical practice is far from inexpensive today. From medical malpractice insurance, personnel costs, operational costs, rent, and other administrative costs, the everyday costs of running a practice can be quite high.
Also, under many laws at either the state or Federal level, as well as under insurance carrier in-network contracts with doctors, providers are required to bill patients for their portion of a bill. So, patients are expected to pay for co-pays, coinsurance, and deductibles as required under their insurance plans.
Medical doctors are required to bill patients for the patient’s portion of the cost of medical care. If a doctor does not do so, he may face legal and financial penalties from regulators and insurance carriers. For example, an insurance carrier may reduce a provider’s payment by the percentage of the payment that the provider failed to bill the patient for. For example, if the provider billed a service at $100 with the insurer paying $80 and the patient to pay $20, but the patient was never charged, then the insurer may request a reimbursement of 20% of the $80 since the insurer only agreed to pay 80% of the total bill.
ERISA
The Employee Retirement Insurance Security Act (ERISA) is a Federal law that establishes minimum standards for employer-sponsored retirement plans as well as health insurance plans. While ERISA puts many requirements on employers regarding how they administer plans for their employees, providers may also be subject to ERISA.
Under ERISA health care plans, employers must provide their employees with health insurance plan information. As such, employees are expected to know and adhere to their responsibilities in paying for their share of the medical bill, such as coinsurance, copays, or deductibles.
Alternatively, insurance carriers representing employers are required to follow certain notice and disclosure rules in working with providers in providing reimbursements. Insurance carriers must be open and transparent about their policies and payment decisions under ERISA plans. In other words, insurers cannot simply deny claims or dramatically underpay claims without a reasonable explanation.
State Prompt Pay Laws
Some states, including New York, have prompt pay laws. Under prompt pay laws, insurance carriers are required to pay “clean claims” (medical claims from providers without any missing or incorrect information) within a certain number of days, such as 45 days. So, if insurers are dragging their feet on claims by neither approving or denying them then they may be violating state law. As a result, it may be necessary for a provider to reach out to the state insurance commission, or similar agency, and file a complaint. Doing so may push the insurance carrier to improve their processes and pay in accordance with the law.
Contact a Knowledgeable Law Firm for Guidance
Creating and maintaining a business can be a daunting endeavor. The experienced and dedicated attorneys at Callagy Law are ready to help answer your questions about forming a business or ensuring that your existing business is in compliance with the law. Contact Callagy Law now for legal guidance.
More information on Callagy Law’s Medical Revenue Recovery program click here.
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