And welcome back for another episode of T-bone Speaks.
I’m your host Dr. Tarun Agarwal and we are here today for an episode of #AskT-Bone.
We have been submitted a question today by Jeremy and before we get to the question today I want to draw everybody’s attention to this podcast so this #AskT-Bone segment is totally driven by questions that you submit. So, if you could take the opportunity to submit questions by visiting www.tbonespeaks.com there will be a form there to submit questions, or even a button that you can click to actually leave a voicemail and submit all your questions, that would be greatly appreciated, so we greatly appreciate you doing that as it does Drive the podcast and gives us things to talk about.
So, our question today is from Jeremy, he says:
I just purchased a GALILEOS and I’m using it similar to how I was using my Panorex as in taking images within every 3 years to screen patients along, with using it for specific implant diagnostic and surgical needs. We utilize code for medical billing and have been billing medical impossible to try to receive benefits. I’m not charging my patients anything for CBCT, part of the screen and do not plan on charging for it. From listening to your podcast, it sounds like this might be how you approach a CBCT Imaging. I’m not in contract with any medical insurance. I am not actively seeking payment from patients to cover deductibles or copayments in this situation and just taking any payment I receive from medical insurance as a plus and making it end up as a wash in the accounting. I initially based as zero my ledger and then I change the fee to equal any payment I received from insurance for it becomes zero again. I read some articles stating that waiving deductibles and copayments can be considered fraud. How do you approach to the situation?
Thank you for your time.
Jeremy, thank you for submitting this question and congratulations on investing in Cone Beam Imaging and utilizing Cone Beam Imaging. It is one of the most valuable and most fantastic tools we have for Diagnostics in our practice, and I hope that everyone listening that has Cone Beam is utilizing medical insurance to help your patients pay for a Cone Beam and help your practice get reimbursed.
I do want to address something: it is fraud to wholesale, not charge your patients co-pays and not charge your patients deductibles. If you are billing medical insurance you must make an attempt to collect your patient portion co-pays and deductibles. To Simply waive those deductibles, to waive those co-pays, to wave your patient portion is fraud. We do not Advocate this, this is not what we are doing in our practice.
The other thing that can get practices in trouble is what you bill medical insurance should also match what you bill dental insurance. So you can’t bill medical insurance one fee and bill dental insurance another fee. You need to have a consistent fee across the board between dental and medical insurance. So I encourage you to make sure that you are doing that as well.
In terms of how we are doing it in our practice, we are billing medical as a primary for Cone Beam Imaging, when we know that our patient has a very high deductible and that Cone Beam will not be covered due deductible, we are not billing medical in that situation. We are simply either charging the patient a Panorex fee or going to dental for the Panorex only, and not billing out a Cone Beam at all.
The other things that we are also doing is we are making sure that we are also in network with medical insurance, and what we are finding is that when we are in network with medical insurance many times ductables don’t apply for Imaging and co-pays are significantly lower and or non-existent for Imaging as well. So I certainly encourage you to make sure that you are taking a look at being in-network and seeing if that makes sense for you in your practice and in your state.
And the other thing I would say is it doesn’t sound very comfortable to me to be posting it as zero and then changing the fee to whatever medical insurance pays. That sounds a little bit fishy and can be construed as a fishy if you ever be audited.
So, thank you for submitting the question and I hope you guys find this helpful and if you could do me a favor, if you find our podcast and our question and answer sessions helpful please do us a favor and share this through social networks, encourage yourself and your friends to subscribe to our podcast either on iTunes or Google play or Stitcher and just help us spread the word
Thank you very much and hope everybody has a wonderful day!
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