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Provider FAQ | Cash Medical Care
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NEWS

Provider FAQ

By admin | In FAQ, Uncategorized | on November 26, 2013

What is the future of medical and dental care in America?

This is the million dollar question. One thing is certain,  deductibles will be going up and patients will be responsible for more of their medical care than ever before.  Recent reports suggest that the slowing of the cost increases in health care can be attributed in part to rising patient deductibles  and out of pocket expenses.

The Affordable Care Act will offer consumers choices in deductibles, out of pocket expenses and co-pays. With deductibles ranging from $2000 to $4000 per person, consumers are moving to a cash medical model already.  What CashMedicalCare.com intends to do is provide patients with pricing data and knowledge to help them make the best decision for their health care spending.

Is this site associated with any organization or group in the medical or dental industry?

Our site is independent of any provider, insurance carrier, or government entity. We are not funded directly or indirectly by the health insurance or medical industries. We are not required to maintain any sensitive relationships with groups of hospitals or physicians.  We do not bury pricing information in a maze of contracted care models. Our mission is to change the health care marketplace by putting the customer and provider back in charge of their medical experience.

Although we accept pricing data and offers from a variety of providers, labs, imaging centers, dental groups and plastic surgeons, our primary aim is to serve consumers. We have no interest in taking money or data from third parties that seek to deter us from that primary focus in any way.

How do I respond to insurance companies that want the same pricing at CashMedicalCare.com?

The answer is simple, tell them of course they  have the same pricing.  They must agree to book their patient through CashMedicalCare.com, pay for services up front, not have any pre-authorization for procedure.  They must agree that no coding or coding reviews will take place, that there will not be any chart reviews or utilization reviews, and that you can conduct the procedure or visit exactly the way you and the patient decide is best for their care.

Special Services – Care contracted and booked through CashMedicalCare.com is often Special Services.  We encourage you and the patient to provide exactly the care you both agree to. You are not using  typical billing codes as they are not part of the patient care process. Your notes are more than suffice to document all the aspects of the treatment you provide.  Some examples of Special Services may include an MRI facility  that gives discounts for early morning or late evening slots, and the gastroenterologist who gives free initial consultations to those who decide to go forward with a colonoscopy.  

Online / Paperless  – No complex systems or documents are required.  All arrangements are booked with CashmedicalCare.com and there are no time consuming pre-authorizations.  In most practices there is a full time staff person assigned to haggling with insurance companies on behalf on patients. This staff cost is absorbed 100% by you.  It is estimated that stripping out all billing, pre-authorizations and fights for denied claims could reduce your practice cost by 22%.

 Administrationless – Other than scheduling, there is no administration required whatsoever–no utilization reviews, no pre-authorizations, no letters of medical necessity, and no phone calls to or from carriers.  The relationship for care is between the patient and the provider and no one else.

 Prompt Pay – Paid for at the time of service, directly and promptly. What is the time value of money for your practice? During a recent government shut down Medicare payments were held for a few weeks.  Did you hold off making your staff payroll? Money at the time of service is very valuable to your bottom line.

 Denial Free – With Prepay and Contracts for service, the risk of denial is negligible.

Information for Medicare Providers

Services or patients not covered by Medicare are not subject to Medicare rules and regulations (based on information obtained from the Medicare office at 701-277-6782).

Can non-Medicare patients be charged a CashMedicalCare.com price?

YES

Can Medicare patients be charged a CashMedicalCare.com price if the service is NOT covered by Medicare (Ex. Annual Physical Exam)? 

YES, but the Medicare patient should be asked to sign a private contract that acknowledges that the physician or practitioner is not limited in the amount that he or she may charge the beneficiary for the items and services furnished.  In a private contract, the Medicare beneficiary agrees to give up Medicare payment for services furnished by the physician or practitioner and to pay the physician or practitioner without regard to any limits that would otherwise apply to what the physician or practitioner could charge. Learn more about ABN forms and Medicare rules and regulations HERE.

Can Medicare Part A patients be charged my CashMedicalCare.com price for Part B physician services if they do not purchase Medicare Part B?

YES

Information for Non-Medicare Providers

According to HCFA Pub. 60B, providers who opt out of Medicare may charge a different price for Medicare covered services.

Can I charge Medicare patients the CashMedicalCare.com price for services covered by Medicare?

YES, but the Medicare patient should be asked to sign a private contract that acknowledges that the physician or practitioner is not limited in the amount that he or she may charge the beneficiary for the items and services furnished.  In a private contract, the Medicare beneficiary agrees to give up Medicare payment for services furnished by the physician or practitioner and to pay the physician or practitioner without regard to any limits that would otherwise apply to what the physician or practitioner could charge.

Can I charge Medicare patients a CashMedicalCare.com price for services NOT covered by Medicare? 

YES, Since Medicare rules and regulations do not apply to items or services not covered by Medicare, a private contract is not needed to furnish such items or services to Medicare beneficiaries (such as routine physical exams and cosmetic surgery).  Similarly, where a beneficiary, who is enrolled in a Medicare risk-based managed care plan, goes out of plan to acquire a service and the plan does not cover it, the enrollee is liable for the full charge for the service and the physician or practitioner does not need to sign a private contract to collect payment for the non-covered service. The above information is based on our research and information provided by HCFA, it is for educational purposes only and is not intended to substitute for appropriate regulatory or legal advice.  For additional information, we suggest you contact HCFA directly or your legal counsel.

Can patients apply my fees/invoice toward their medical deductibles? 

That decision is between you and your patients. We encourage you to provide your patients with a detailed invoice of the elements of your visit and code these invoices in nationally acceptable terms including ICD9 and diagnostic codes. Each insurance plan is different. Some have “in” network and “out of” network deductibles. Before your patient books a MRI or blood test that you order they can easily contact their insurance carrier to find out if the service will satisfy the “in” or “out of” network deductible.

Is CashMedicalCare.com legal?

We have worked with our lawyers to ensure that CashMedicalCare.com fully complies with all laws governing health care and insurance. CashMedicalCare.com is designed for those without insurance and those with high-deductible or major medical insurance.

We do not use hard sell or pressure tactics on clients looking for a service. We are a booking service that helps market your services. We are simply a clearing house to post pricing and connect you with patients.  We do not collect health care information on the patient nor do we offer advice on medical care. When the patient requests a service we send them information on our medical and dental vendors and leave it in their hands to follow up, do the due diligence on your services and book and pay for your services. Our system is the ultimate in ‘opt in’ marketing and the patient is in total control of where they end up receiving care.

We have been assured by Medicare that patients who are not receiving benefits from the Medicare program do not fall under Medicare guidelines and you are free to charge them what you want.

It is important to remember that CashMedicalCare.com is NOT designed to be a “discount” program.  It is designed to be a program that allows doctors to charge a fair and reasonable price for their service, and be reimbursed in full at the time of service, without incurring the high expense of billing and coding associated with most insurance and third party contracts.  Medicare patients may still benefit from CashMedicalCare.com if a service is not covered by Medicare (cosmetic surgery, dental, preventive services etc.)

Patients also have the right to specifically tell you no to bill Medicare for confidentiality reasons, and CashMedicalCare.com may benefit them in this situation also.   This information does not substitute for legal advice.  If you are still concerned about the legality of CashMedicalCare.com, please consult your attorney.

What is my “best price” anyway?

You establish the CashMedicalCare.com price that is fair for you and your patients. By eliminating administrative costs associated with activities such as:

  • billing
  • producing insurance claim forms
  • coding diagnoses and procedures
  • referrals
  • authorizations
  • payment delays
  • EOB reviews
  • claim denials
  • re-submissions
  • collection risks
  • managed care costs

you provide patients a fair price for services without the administrative hassles and bureaucracy.  Many physicians reduce their standard billed charges 30% to 50% for CashMedicalCare.com patients and benefit financially, but your CashMedicalCare.com price is your decision.

How does CashMedicalCare.com help me attract new patients?

CashMedicalCare.com is a service whose time has come.  Patients are referred to your practice by visiting CashMedicalCare.com and requesting a service.  As you know, patients are using the web more than ever to understand health care issues. CashMedicalCare.com has a sophisticated online market program with the key word, SEO (social media and organic) search strategies that help clients find services at a cash price.  We work with a number of medical and dental providers and encourage our medical and dental providers to offer aggressive pricing.  We are matching patients to pricing.  The better value you provide. the more patients we can book for you.

How long will my agreement be in effect?

Your initial agreement with CashMedicalCare.com is in effect for one year from the date the agreement is signed and will automatically renew until formal notification of withdrawal from the plan is received from you.  You, as a medical and dental provider, can move in and out of the pricing model with CashMedicalCare.com whenever you would like. Our model is based on you providing pricing information to consumers. If you have gaps in your schedule, CashMedicalCare.com can help.

 Can I follow my established office policies and practice philosophy?

CashMedicalCare.com does not restrict your methods or philosophies of treatment – those remain strictly between you and your patients. Nor are you required to alter your office policies in any way. We only ask that you charge the fee you offered to your patients when they book an appointment.

What if I am affiliated with another discount  plan?

Your participation as an CashMedicalCare.com provider is not affected by your participation in other plans. Coordination of benefits is left to your discretion.

How do consumers find CashMedicalCare.com?

Most CashMedicalCare.com users have made a personal commitment to take control of their health care and dental needs by searching our site for the best value for their care dollars. We also promote our programs to small to mid-size business owners and their employees.  Our marketing includes working with medical and dental providers to offer our information to their clients. Many times a Doctor will refer  a patient for a medical test such as a MRI only to find their insurance deductible or co-pay is a financial challenge. CashMedicalCare.com becomes a tool to help the Provider get the test he needs to properly care for their patient and the patient to be able to afford the test.  CashMedicalCare.com is also marketing its services in Mexico.  Many Mexican nationals are looking for specific American medical procedures.

If you would like to offer service to our clients click HERE for more information.

 

  • CashMedicalCare.com is not responsible for medical services, dental services, products or credentials of any CashMedicalCare.com providers.
  • CashMedicalCare.com is not an insurance company and does not manage medical care. We simply put you in touch with patients that want your services.
  • CashMedicalCare.com is a free market based program that does not regulate, control or dictate the fees that our provider members charge.

 

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