Saturday, July 7, 2007

Do patients have to give Social Security Numbers to Medical Providers?

It was a sunny Saturday morning and in comes our last patient of the day. The office was cleared out and I thought this was going to be a quick in and out patient. I handed the patient his "new" patient registration forms and went back to my desk hoping to complete my confirmation phone calls so I could leave the office on time.

A few minutes later the patient came to my desk and gave me the completed patient registration form. I quickly scanned through it and saw that the social security number was missing. Sir, can I get your Social Security Number. He explained politely that he does not give it out. I let the patient know that I appreciated his reasons for not wanting to supply this # but explained that the provider has policies to not treat patients without the social security number.

I went to the doctor and notified him of the situation. The next hour I went back and forth between the doctor and the patient explaining each others side. Finally, the doctor came from his room and explained that he has the right to deny services for the patient not supplying the social security number.

In the end the patient gave the social, the provider treated the patient and everyone was happy but the question that many of my colleagues asked me is" Does the provider have the right to deny services for a patient who does not want to give his social security number?"

The answer is Yes.

Patient's privacy rights can be found at
http://www.privacyrights.org/fs/fs10-ssn.htm and it clearly indicates the patient has the right to not give their social security number for a medical office visit however the provider can choose to deny services.

Our only reason for gathering our patients social security number is if the patient defaults on their bill and must be sent to an outside collection agency they can find the patient and collect.

The patient eventually understood we weren't going to resell his information to anyone. And after spending 1 hour working with me and the provider he trusted that we would not only treat his body and his patient medical records with respect.

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Can Providers bill for Missed or No Show Visits?

A client wrote me last week the following scenario:
8:00 am and all is quiet. A quick glance at the schedule let's me know that I am going to have a busy day so I need to enjoy this brief moment before things pick up. I have over 20 patients scheduled and 1 doctor to treat them all.


The middle of the day and things are going well. I look at the schedule and we have treated 10 patients so far. 1/2 done YEAH our next patient is a sweet elderly woman who started getting treated a few months ago. She is usually a few minutes early but today it appears she is really behind putting me behind schedule. I call the patient and identify that she hasn't even left her home but completely forgot about her appointment .

We rescheduled her appointment but now I am in a dilemma. Can I bill her for this visit as a No Show? She is a Medicare patient but can we bill Medicare patients for No Shows? We charge $35.00 for our other patients who do not cancel within 24 hours.

The answer is YES
Medicare has stated that a provider can bill Medicare patients for missed appointments not as a service but as a missed business opportunity. The provider is responsible for billing all of their patients the same and can not discriminate against Medicare beneficiaries.

If the provider accidentally bills Medicare for a missed visit charge Medicare will process the claim and submit a EOB with Reason Code 204: This service or equipment/drug is covered under the patient's current benefit plan.

To read Medicare's complete statement:
http://www.cms.hhs.gov/transmittals/downloads/R1279CP.pdf
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5613.pdf


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Claim Adjustment Reason Codes and Remittance Advice Remark Codes

HIPAA of 1996 instructs health plans to be able to conduct standard electronic transactions (submission of claims, claims inquiries, electronic remittance advice, etc.) adopted under HIPAA using valid standard codes.

Read this entire article at to learn more:
Medicare Health Insurance

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