Frequently Asked Questions About Your Hospital Bills The Registration Process Why do I have to verify my address each time? Though address and telephone numbers remain constant for approximately 70% of us, verifying this information is essential in our billing and collection processes. Why don t you keep the information available so you can retrieve it without reentering it? Demographic information is considered valid for a certain period of time. At Johnson Memorial, 120 days is our revalidation time. Despite verifying the information, we still receive some mail each week with invalid addresses. Why must I show my insurance card each time? Insurance coverage changes more frequently than addresses. Your card provides the precertification telephone numbers, claims address and group numbers that are essential to us as your insurance advocate and to the processing of your insurance claim. As an industry standard, insurance information is considered accurate only at the time of service, thus the need for revalidation each time you are seen. But I have Medicare and it does not change. Why do I have to show my card every time? Information contained on your Medicare card defines the correct billing expectation Medicare requires. While 99% of the time this does not change, our 120-day revalidation period necessitates that we renew the information in our system. I am retired and have Medicare. When I come in, you ask about my and my spouse s employment status. WHY? Medicare is a last payer insurance. Federal law mandates that all Medicare providers verify at each visit that you or your spouse does not have an Employer Group Health Plan that would be primary over Medicare. When audited, we have to show proof that for each time you received services, you were asked specific questions relating to the possibility of other insurance. Additionally, if you are in an accident and someone else is at fault, the other party is responsible for your medical expenses according to Federal Law.
Sometimes I have to wait for medical tests because you need an order. What is this? Similar to a pharmacy filling a prescription, a physician s order must be on file requesting a diagnostic test before we can perform a service. If we do not have record of the order and it is not presented at the time of service, we must call the physician s office and request the order be faxed. The results are then directed to the ordering physician who will confer with you regarding the results. Diagnosis All insurance companies require a valid diagnosis to enable them to determine the benefits due. It is the physician s responsibility to provide the hospital with a diagnosis. If you have questions concerning the diagnosis, you should contact you physician directly. Screening-Wellness Testing: If you have benefits under your insurance plan that allows for annual wellness or preventative testing it is important that you tell the Physician and the JMH Registrar. Once a claim is filed with your insurance it becomes an historical fact and cannot be changed by the hospital. Medicare Patients: The purpose of an ABN is to give the patient notice--before a service is provided that the hospital believes it is unlikely that Medicare will cover the test, procedure, or therapy that your doctor has ordered. The ABN will list the service, explain why the Medical Center believes Medicare might not pay, and inform you that you will be fully and personally responsible in the event that Medicare does not pay. After being informed that Medicare would not cover a test, if you choose to go ahead and have it, you are accepting responsibility for payment of the service. If an order does not support the medical necessity at the time of the test, it will not support after the test. This can be construed as Fraud & Abuse. Commercial Payers: Commercial carriers will ask for the medical records anytime a change in the diagnosis is made to make sure JMH is not committing insurance fraud by trying to get the member better payment. IF the insurance plans only look at the first diagnosis and the diagnosis is coded and on original Order, we inform them that this was not correct that all diagnosis needed to be considered. When the diagnosis is not present on the original order it becomes the patient/insured responsibility to work with their insurance carrier to collect the benefits of their insurance plan.
Medications for Medicare outpatients Drugs that are considered self-administered and drugs that can be used at home are not covered by Medicare in the outpatient setting. The outpatient setting is: Observation, Emergency Room and Same Day Surgery. These charges will be bill to you on a Medicare Part D statement that will have the required information necessary for submission to your Medicare Part D Drug Plan. The Billing Process Will you bill my insurance? Johnson Memorial will act as your insurance advocate and bill your insurance carrier for services rendered. The hospital expects payment from you or your insurance company within sixty days of discharge. If your insurance has not paid, you should contact them directly. Precertification or prior authorization Many insurance companies now require advance notice of admission or service. You should contact your insurance company immediately when your physician determines that you need to be admitted or have an outpatient service to obtain this authorization. Precertification does not guarantee payment of the bill. Coordination of benefits Group insurance companies coordinate their benefits. This is to reduce duplication of payment for the same service. We ask that upon admission, you give us all insurance information for all policies for which you are eligible for benefits. We will submit this information to your insurance company, who will coordinate the benefits and pay appropriately. Third party liability In cases of injury resulting from an accident, Medicare and Medicaid require that the hospital bill the liable party (car insurance or homeowners insurance) for services before Medicare/Medicaid is billed. Some insurance companies also have this requirement. Again, this is to avoid duplication of payment. Except for Medicare/Medicaid patients, you will need to bill any other party liable for you services. My insurance requires a PCP referral whenever I go to the Emergency Room. Who is responsible for obtaining the referral?
It is your responsibility to tell your physician that you were in the Emergency Room, but if your condition requires admission to Johnson Memorial or another hospital, your physician will be notified by the hospital. If you do not obtain a PCP referral, you will be responsible for the bill. Will I be billed if insurance does not pay timely? You will be notified when we bill your insurance and when we are sending our third request to your carrier. You will be sent a letter advising you that your insurance has not paid and if payment is not received from them in 30 days from the date of the letter, you will be billed. If you have not received notification from your insurance carrier that your bill has been paid within 60 days of the date of service, you may want to call your insurance carrier to determine the reason for the delay in payment. Why didn t insurance cover shampoo and other personal items used during a visit? Insurance plans consider personal items such as shampoo, toothbrushes, lotions, etc. not medically necessary, therefore not covered. When you request these items, you will be expected to pay for them. Will you help me with any insurance questions? The billing staff at Johnson Memorial is willing to assist you with any insurance questions, even if it does not relate to services provided by JMH. With your approval, our staff of insurance specialists will assist you in the appeal of insurance denials and clarity of payment issues. What if I am injured at work? Johnson Memorial will notify your employer and bill them for the services rendered. If your employer denies the claim or fails to pay within 90 days, we will consider the bill due from you. You may, however, request that we submit the claim to your medical insurance at this time. Johnson Memorial can only hold a claim if a dispute arises between you and your employer regarding the validity of the worker compensation claim after a claim has been filed with the Indiana Worker s Compensation Board. When Do I Pay? I know that I will owe a deductible or co-pay. When will I have to pay?
Though you may pay the amount prior to the receipt of a bill if you know the amount required, we bill for deductible and co-pays after receipt of payment from the insurance company. You will be expected to pay this amount on receipt of the bill. I do not have insurance. What options are available to me? If you meet criteria for coverage, Johnson Memorial offers Medicaid application assistance. We offer assistance through an external consulting firm for the application process. If you are above the financial guidelines for Medicaid, we offer monthly payment options. Johnson Memorial offers no interest shortterm payment plans. For longer-term payment plans, an outside agency is available to help you. What if I do not have the money to make monthly payments? Johnson Memorial has a Financial Assistance Policy to assist qualified applicants from a range of 5 to 10 percents, depending on income and assets. Applications are available upon request. Why so many bills? You will be receiving a bill for services provided at Johnson Memorial Hospital. Depending on the tests or care you received, you may received bills from one or more for the following groups: Community Cancer Care, Emergency Medical Group, Inc., Indiana University Radiology, Johnson County Pathology, Johnson County Internal Medicine, or Southern Indiana Anesthesiology. Contact numbers: General Information: (317) 738-7880 Copy of Itemized Bill: (317) 738-7878