In compliance with the Federal Consumer Protection Act, Austin Medical Group PLLC is furnishing you with information regarding your financial responsibilities.
We are pleased that you have chosen our office for your healthcare needs. We would like to familiarize you with how our services are billed, which insurance claims we file on your behalf when we request payment from you and our credit policies. Please take the time to read this policy and if you have any questions please speak to the practice administrator or billing specialist.
Due to federal law, a VALID IDENTIFICATION (driver’s license, ID card, passport, military ID) and CURRENT INSURANCE CARD must be presented at EVERY OFFICE VISIT. If your name does not match your insurance card, we will be unable to file your insurance and you will be responsible for payment in full for services rendered. These measures have been enacted to protect you from insurance fraud and identity theft.
Any applicable deductibles, co-insurance or co-payment are due at the time services are rendered.
You should understand that the primary-insured is financially responsible for any balance not covered by their insurance including deductible, co-insurance, co-payment and any services excluded by their policy.
If you have Medicare primary: You have a deductible to pay at the beginning of each year. Once that deductible is met, Medicare pays only 80% of the allowed charges. There is a 20% co-insurance due, and if you do not have a secondary insurance or your secondary does not cover the 20% in full, you will be responsible for that balance at the time services are rendered.
Please note that we collect money based on verbal, faxed or internet communication with your insurance; if there is a miscommunication by your insurance carrier and the correct amount is not collected, you will receive a bill for the balance. Overpayments will not be refunded until all outstanding claims have been processed by insurance and balances settled.
It is always your responsibility to understand the coverage of your insurance policy and its referral/authorization process.
Please understand that our office cannot accept responsibility for payment/non-payment on your insurance claims. Questions about coverage and benefits should be directed to your insurance company.
BILLING AND COLLECTION POLICY
Any invoices received from our office are due immediately upon receipt. If for any reason you cannot pay the bill in full, we ask that you contact our billing office to set up a payment plan. An interest rate of 1.5% per month may apply to any invoice over 30 days old. If you fail to respond to the bill or fail to cooperate with the terms of your payment plan, your account may be turned over to an outside agency for resolution. If this occurs, you agree to be legally responsible for any and all collection fees which include, but are not limited to, a 33% agency fee (an additional 33% of what you owe) along with any and all attorney and/or court fees.
To avoid problems due to delayed mail, it is your responsibility to notify our office of any changes in your name, address, phone number or insurance coverage.
We do not offer in-house payment plans for deductibles. All deductibles must be paid in full at the time of service. We accept cash, check, Visa and MasterCard. There is a $35 fee for any returned check.
CANCELLATION / MISSED APPOINTMENTS POLICY
If you are unable to keep your scheduled appointment, please give our office a minimum of 24 hours notice so we can accommodate another patient in your time slot. If you fail to do so, a no-show fee will be applied accordingly ($50 for new patients and $25 for return/follow-up patients). Please note that there will be a $100 fee if you are scheduled for any procedure/testing and you fail to provide at least a 48-hour notice of cancellation of your appointment.
MEDICAL RECORDS AND FORMS
A form to request transfer of your medical records to our clinic is available on our website. To send your records from our clinic to another physician, we need a written request from you. We require an appointment for completion of forms (FMLA, insurance screening, prior authorizations, etc). If forms are sent or dropped off at our office to be completed on your behalf, a fee of $25 will be due before the form can be processed. You should allow at least 7 days for completion of any forms.
PRESCRIPTION REFILLS AND PREAUTHORIZATIONS
Prescriptions are typically given at office visits with enough refills to last until your next follow-up visit. You should inform the medical assistant at the BEGINNING of your visit about any refills you need. Please make sure that the pharmacy on file for you is correct. In the event that a refill is needed sooner, you should contact your pharmacy so the refill can be requested electronically. If your insurance company requires a preauthorization for your medication, you can discuss options for a different medication with your pharmacist or insurance and have them contact us to request a change. We do not have access to your insurance company formulary (list of approved medications). If there is paperwork to be filled out, you may be required to be seen at a regular office visit so the appropriate documentation can be sent to your insurance.
CONTROLLED SUBSTANCE POLICY
Controlled substances include narcotic pain medications, some anti-anxiety medications, attention-deficit medications and some sleep medications. These medications can be habit forming if misused and extremely dangerous/lethal when combined with certain other medications.
The physicians at Austin Medical Group do not prescribe chronic pain medications. If your condition warrants repeated use of pain medications, you will be referred to a Pain Management Specialist.
The physicians at Austin Medical Group do not prescribe benzodiazepines (anxiety meds) for long-term use. If your condition warrants repeated use of such medications, you will be referred to a Psychiatrist.
Refills for these controlled substances are subject to a $10 administrative fee if there is no office visit at the time the refill is being picked up. Patients prescribed controlled substances agree to urine drug screening on an annual basis; additional urine drug screens may be required at the prescribing physician’s discretion.
In a constantly changing healthcare environment, AUSTIN MEDICAL GROUP is committed to educating their patients about healthcare issues that affect them. As a result, they have provided general information about the Health Insurance Portability and Accountability Act (HIPAA) of 1996 for your review. AUSTIN MEDICAL GROUP is complying with HIPAA regulations and will be happy to answer any additional questions you might have.
WHAT IS THE PRIVACY RULE?
The Privacy Rule is part of the HIPAA regulation of 1996. The Privacy Rule establishes a federal requirement that doctors, hospitals or other healthcare providers and health plans obtain a patient’s written consent before using or disclosing a patient’s personal information to carry out treatment, payment or other healthcare operations.
WHAT IS PROTECTED HEALTH INFORMATION (PHI)?
Protected health information (PHI) means any personal health information as defined by law, including demographic information collected by a healthcare provider or other entity that could potentially identify the individual. PHI includes all medical records and other individually identifiable health information held or disclosed by AUSTIN MEDICAL GROUP regardless of how it is communicated (e.g. electronically, written, or verbally.)
WHAT IS TREATMENT, PAYMENT OR HEALTHCARE OPERATIONS (TPO)?
TPO refers to the treatment, payment or healthcare operations of AUSTIN MEDICAL GROUP. In other words, quality patient care; ensure that the physician is paid for services; and, operate the business. Some examples of these activities are the use of PHI by the physician and clinical staff to treat a patient; Use of PHI by administrative staff for strategic planning and internal management activities.
WHY DO I HAVE TO SIGN A CONSENT FORM?
In order to use or disclose your PHI, AUSTIN MEDICAL GROUP is required to obtain a signed consent form from you to directly treat you or carry out healthcare payment and business-related activities. AUSTIN MEDICAL GROUP is not required to obtain your prior consent in an Emergency, when AUSTIN MEDICAL GROUP is required by law to treat you, or when there are substantial communicable barriers. AUSTIN MEDICAL GROUP reserves the right to refuse to treat you if you do not sign the consent form.
WHAT IS THE DIFFERENCE BETWEEN CONSENT AND AUTHORIZATION FORMS?
In order to use or disclose your PHI for specific purposes, other than direct treatment, payment, or healthcare operations, AUSTIN MEDICAL GROUP is required to obtain a signed authorization form from you. For example, if you request AUSTIN MEDICAL GROUP to disclose PHI to a third party, you must sign an authorization form. This authorization form is more detailed than a consent form and has a specific expiration date.
AUSTIN MEDICAL GROUP has provided information regarding the NOTICE OF PRIVACY PRACTICES. This notice describes the practice’s commitment to privacy, my rights to privacy and how AUSTIN MEDICAL GROUP may use and disclose protected health information (PHI) about me to carry out treatment, payment and healthcare operations.
By signing this form, I am acknowledging that I have reviewed the NOTICE OF PRIVACY PRACTICES which explains how my medical and personal information will be used and disclosed, I understand that I am entitled to receive a copy of this document upon request.
Austin Medical Group General Policies Update 2018
As we welcome in the new year, we would like to remind you of our general office polices. Keeping these policies in mind will allow us to provide the highest possible care to all of our patients.
Appointments & No-Show Policy
· Your time is valuable, and so is your doctor’s. We ask that you cancel your appointment at least 24 HOURS in advance. Calling the day before will help us make that appointment available to someone who may need urgent or sick care.
· Please make sure we have your most up to date contact information. Our system will notify you by phone, text, or email of your appointment 1-2 days in advance as a courtesy. However, you are still responsible for keeping your appointment time even if we cannot reach you.
· Persistent no-shows may result in dismissal from the practice. Fees will appear on your statement as a service code 99199 and will be assessed as follows:
$25.00Missed office visit$50.00Missed New Patient, Annual exams*, 30 min appt.$100.00Procedure, Allergy Test
*This exam gives us a chance to address your overall physical and emotional health. The preventative care we provide during your annual includes an assessment of your dietary and exercise habits, review of vaccinations and discussion of appropriate screening tests. This visit is not meant for discussion of new or ongoing problems. If new or on-going problems are discussed, you may be billed by your insurance company or your visit may be converted into a normal office visit at the discretion of the physician.
· All patients who are prescribed medications must come in periodically for medication follow up at the discretion of your physician. Failure to keep these appointments may result in denial of prescription refills until an appointment is made. Prescriptions are sent electronically to the pharmacy you have listed on file. Please allow 48 Hours for all refills to be processed. If you would like to discuss making a change to your medications, please call and schedule an appointment. Staff will not be able to make these changes.
· If you are currently being prescribed a controlled substance medication, you are required to make an appointment and follow up in office every THIRD refill. After your appointment, you will be able to call the office and request a refill during the appropriate timeframe. There is a $10.00 administrative fee that is collected for each refill and your prescription will be electronically sent to the pharmacy on file. There is no exception to this policy, and is done as a courtesy to our patients. 48 HOURS must be given to fulfill these refill requests.
· **PLEASE NOTE** 90 DAY SUPPLY OF CONTROLLED SUBSTANCES ARE NOT ABLE TO BE PRESCRIBED
· Please make sure your pharmacy on file is correct, as these prescriptions are not able to be transferred and may delay the receipt of your medication. Calling your pharmacy ahead of time to make sure the medication is in stock can also help avoid a delay, as these medications periodically become unavailable at certain pharmacy locations.
· If your insurance requires a referral, you must be seen at least once in this clinic by your physician for this issue.
· Once a referral has been created, please allow 3 days for your referral to be processed and authorized by your insurance company. Once approved, the referring office will contact you to schedule an appointment.