As an acupuncture billing company serving hundreds of providers in 27 states we notice trends with insurance companies quite literally before anyone else. We strive to let you know what is happening in the acupuncture billing world before it costs your practice money.
In the past few weeks our account managers have reported higher than usual calls from acupuncturists seeking advice on how to handle refund requests from payers. We have analyzed these requests to discern any patterns and here is what we are able to identify thus far: The refund efforts seem to be initiated by Cigna, United Healthcare and Mail Handler’s Insurance. The focus of their requests is largely on long term patients, for either evaluation and management procedures codes (CPT Codes 99211-99215) or codes relating to additional acupuncture units (CPT Codes 97811 and 97814).
State regulations regarding insurance recoupment vary drastically. Some states, such as Minnesota, do not have a time limit statute set for insurance companies to request refunds based upon overpayments, duplicate payments, pricing changes or coverage changes. Other states, such as Texas and Maryland only allow six months for an insurance company to request a refund. Therefore, depending on what state you are in and depending on what the refund request is issued for can make a difference on how long the insurance company can request their money back.
So how should you handle these requests? First of all, if you disagree with the insurance company’s stance, never refund the monies. Just say no! It costs the insurance company approximately $3500-$5500 a day for arbitration. You should contest any letter you receive as soon as possible and make it perfectly clear that you plan on fighting the payer’s refund request. Insurance companies will always weigh the expense of arbitration and the likelihood of winning against the amount of money they are trying to collect. Here are some sample letters to get you started. SAMPLE LETTERS.
Once you send your response letter, you’ll want to follow-up and ensure the receipt of letter. If you are unsuccessful in resolving the refund request yourself, contact us at solutions@holisticbillingservices.com. We can refer you to counsel specializing in this type of law.
Are you interested in learning more about acupuncture billing services? Here are some additional tips!
And if you are interested in an acupuncture billing service...
{{cta('de868bce-5ed3-40e3-9205-308bcffbebc1')}}
