bit more because a person who's paid for it likely has a greater need and it's going to be harder for insurance to say not necessary wherein as if a patient has never paid dime one to it and only in an insurance phase maybe the patient is getting a few more visits. What I would say to that, Doctor, is they do still have a duty based on their board regulations as to having adequate documentation of information. Certainly, the amount of services provided the patient may not ever question it but the insurance company that paid the patient for it certainly question it. They could. Medical necessity may not be as great but certainly there's still going to be enough information that they have to make sure that they're showing that the services were indeed provided, but I would say it's probably not as great but they're not completely out of the loop. For instance, a lot of doctors who do Medicare as non-PAR and they bill for the patient but the patient pays upfront, those are just as prone to an audit as a doctor who is PAR. So it doesn't change a whole lot when it comes to that and I would say for most if a patient is paying cash, chances are they're not coming for as many visits, and so again, is there going to be as high a likelihood for someone to review? Not as likely, but I won't say it's impossible. One of the experiences that I had with doctors is when the insurance company does do oppose payment audit and you considered it a cash patient they still have a way of sending a letter to the patient and carboning the doctor or vice-versa saying that these services we did not find medically necessary and please let us know if you do not get a refund from the provider, so there are ramifications. I think it's critical that the doctors understand that whether they're billing insurance directly or not they're still subjected to these audits and to the rules and regulations set forth by their board as well as the insurance carriers. Also when we're talking about long-term care, everything that you described is perfect from my perspective on the first part of care, let's just say from a rehab setting, but after that I think that it's important that the doctors also understand that from an insurance perspective, not a chiropractic or a philosophical perspective but from an insurance perspective it's very important to separate out what should be cash after insurance is done because they're responsible for a certain set of care standards. When it becomes a wellness-based care it's very important that the doctor understands that if they want the patient to keep coming in
Stu Hoffman:
Made with FlippingBook - professional solution for displaying marketing and sales documents online