Q. What is your title at Lake Washington Sports & Spine?
A. Billing and Coding Coordinator
Q. What is that exactly?
A. I review each claim coded by the physicians
to ensure they are coded correctly and also edit them when it is necessary. I submit the claims to the insurance
companies and follow up when a claim is denied.
I also am responsible for patient billing including answering any
questions, setting up payment plans and working to ensure all accounts are paid
by insurance and patients to meet a zero balance due.
Q. Many patients ask questions about co-insurance versus a
copayment. What is the difference?
A. A Copay is a payment made by a patient at
the time of service that covers most general office visit consultations (ie: NO
procedures done in office). Coinsurance
is your share of the costs of a health care service NOT covered under a Copay
(ie: an Ultrasound, an injection, basically anything that is NOT a general
visit consultation). Also remember, some
insurance plans do not have copays at all therefore all types of visits
(consultations, procedures) fall under coinsurance only.
For example: Patient “Bob” has Premera. He does not have a copay listed on his
insurance card so we do not collect any copay.
His Premera policy has a $500 deductible that the patient is responsible
to meet before they pay 80% of the claim charges (so basically, Bob has to pay
the first $500 of his medical expenses himself before his insurance pays
anything). Let’s say Bob already met
that deductible and since Premera will only pay 80%, that leaves 20% coinsurance Bob’s responsibility.
Q. What are examples of things that patients need to address
before their visit to make sure that their claims are paid appropriately?
A. If going through a health insurance (Regence,
Premera, Aetna, ect) please make sure you check your benefits in advance and
understand if you will owe a copay that day or coinsurance once your claim
processes. If going through an
accident/injury claim, make sure you provide us with all claim information
including the name of the company we are billing, claim number, claim manager
or adjuster name/phone number and the date of injury. Also, you need to have all chart notes from
other treating providers faxed to us before scheduling your appointment.
Q. Do you have tips for patients so that they can better
understand their coverage and benefits?
A. Contact the
customer service phone number located on your insurance card and provide them
with the name of the physician you’re seeing here. If they are unable to locate that physician
in their network, give the practice name and/or our billing name Emerald City
Sports and Spine Medicine with our NPI (National Provider Identifier) which you
can contact the office for. Ask your
insurance rep if we are in-network or contracted and to see what your benefits
are for your appointment.
Q. From a patient perspective, how does it improve the
quality of the patient experience that you are actually in office, as opposed
to off-site?
A. I can immediately
access all needed documents not scanned into patient charts and also can
communicate directly with the medical assistants and physicians to resolve any
billing issues rather than waiting for an email or call back. Also, if a patient needs to drop off
information needed to process their claim they can do so in office with me
versus again an email or phone call.
Q. What are the characteristics of the ideal patients for
Lake Washington Sports & Spine?
A. Some characteristics include:
•Ready to make a
positive change to become the best version of themselves
•Take responsibility
for their care and do so by showing up on time to their appointments and paying
their bills on time
•Trust in the staff
here to do what’s in the patients best interest; following the physicians
advice in clinical care and knowing we will do everything we can to get their
claims processed through their insurance.
Q. In addition your role as a Billing and Coding
specialists, you often serve as an unofficial "Ambassador of Good
Cheer," accompanying patients on their visits and provide feedback on
patient communication. What are things that you have learned from those
experiences, and how does that translate to better care?
A. I have learned that
some patients look for “counseling” rather than a clinic evaluation which I
feel hinders the patients care. I’ve
learned it’s important to be empathetic to patients but to also steer them
towards specific questions and actions that really focus on getting the patient
better. The physicians have many people
to see in one day and if all they get with a patient is 15 minutes, it’s very
important to utilize those 15 minutes by staying focused on “what can we do as
team to get you better faster!”
Q. Do you feel like your perspectives are valued by Dr.
Chimes and Dr. Hyman? How does that translate to a better patient experience?
A. Yes. When the physicians value my thoughts and
knowledge it allows me to do what I do BEST.
It allows me to bypass long conversations of why we should or shouldn’t
do something and instead get claims processed and paid and work with patient’s
to get their accounts to a zero balance.
Q. Are there common questions or topics that patients should
bring to your attention sooner?
A. Whenever there’s a
change in insurance, let me know ASAP!
It’s very helpful to know when a member id has changed, when an
insurance has switched, when a new accident/injury claim has been
opened...basically anything that changes how your bills will be processed I
need to know BEFORE your appointment to give you my best service available.
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