Billing at Virginia Interventional Pain and Spine Center

In July of 2015 VIPSC transitioned from using a medical management company for all billing and coding to having our own in-house billing and coding department.  During the transition, a great deal of time and effort has been spent in making this transition as seamless as possible.  Though we did have our fair share of “growing pains”, the department is evolving into one of our strongest departments.  The department currently consists of 7 billing, coding and collection specialists many of which are certified professional coders.  Pain management, as a speciality, is a challenging medical field.  The business aspect is no exception.  The billing and coding departments work diligently on a daily basis to file claims in a timely manner and to stay current with rules and regulations within the insurance industry. 

To assist current and future patients in understanding the financial processes encountered here at VIPSC we have provided information below concerning the most frequently encountered types of insurance and payment policies.

  • Proof of insurance is required to initiate care for every patient using their insurance.  Patient must present all insurance cards and a government issued photo ID during their first visit, even if insurance information was obtained by phone or through another provider prior to the initial visit. 
  • Co-pays and Co-insurances are a portion of a patient’s fees not covered by insurance carriers.  These fees are collected on the day of the visit, prior to seeing a healthcare provider.  Insurance contracts between insurance carriers and healthcare providers require the collection of co-pays and co-insurances by healthcare providers.
  • Deductibles are also a portion of a patient’s fees not covered by insurance carriers.  Deductible limits must be met and paid in full by the patient prior to the activation of patient benefits. 
  • Out of pocket expenses are an additional portion of a patient’s bill not covered by insurance carriers.  However, once the out of pocket amount is met and paid in full  by the patient, benefits increase to 100% coverage and the patient is no longer billed.  This remains in place until the patient policy renews.
  • Preauthorization is the process of obtaining the insurances carrier’s approval for procedures the doctor recommends prior to the procedure being performed.  The procedure should not be performed until the preauthorization is obtained.  If the patient receives the procedure prior to the authorization the fees for the procedure will be the patient’s responsibility.  In many cases pre-authorization can be obtained quickly.  Unfortunately, in some cases the authorization can take two weeks or longer. 
  • Primary and secondary coverage occurs when the patient is covered under two distinct full policies, one belonging to the patient and the other belonging to a spouse.  The primary policy is always the policy belonging to the patient.  The spouse’s policy is always secondary. 
  • Supplemental policies are small policies intended to pick up portions of fees not paid by the patient’s primary policy.  Supplemental policies are not full policies and they only cover the remaining portion of fees for “covered services” Covered services are those services covered by the primary policy.  If the primary policy refuses to pay fees for a service “non-covered service” the supplemental policy will also deny payment.
  • Personal injury cases such as motor vehicle accidents are accepted on a cash basis.  Information necessary for the patient to receive reimbursement from their carrier will be provided to the patient. 
  • Worker’s compensation cases are accepted on the basis of our contract status with the carrier or on a cash basis.  If we have a contract with a carrier to treat patients they insure, we accept the case through the insurance policy.  If we do not a contract with a carrier to treat patients they insure, we will only accept the case on a cash basis.
  • No show fees are charged if appointments are not cancelled at least 48 hours in advance.   The fee for missed new patient or procedure visits is currently $100.00.  The fee for missed follow-up visits is currently $50.00
  • There are times when outside parties require additional paperwork not related to payment for services rendered.   In these situations, there is a fee for completing the additional paperwork, typically $25/page. 
  • If copies of a patient’s records are requested, based upon the situation, there may be a fee that is determined by the number of copies produced. 
  • Fees are charged for returned checks.  The amount of the fees is based on the bank’s charges to the practice.   

Our goal is to care for our patients in the most complete manner possible.  This includes healthcare and financial care.