Billing/Insurance

Billing and Insurance information

Florida Medicaid pricing can be located at the following link: http://mymedicaid-florida.com/

Florida Medicare pricing can be located at the following link: http://medicare.fcso.com/

You should contact your insurer or health maintenance organization regarding your cost-sharing responsibilities.

Riverwalk Ambulatory Surgery Center is participating with all major insurance plans, including but not limited to:

  • AARP Medicare Complete
  • Aetna Elect Choice
  • Aetna HMO
  • Aetna Managed Choice POS
  • Aetna Open Choice PPO
  • Aetna PPO
  • Alignment
  • Ambetter
  • Auto Insurances
  • BCBS Health Options HMO
  • BCBS Medicare Advantage HMO
  • BCBS Medicare Advantage PPO
  • BCBS Michigan PFFS
  • BCBS PPO
  • BCBS Preferred Patient Care
  • BCBS Traditional
  • Blue Select
  • Cigna Choice EPO
  • Cigna HMO
  • Cigna PPO
  • Coventry/Mail Handlers/ First Health
  • Evolutions Healthcare Systems
  • Freedom Health Medicaid
  • Freedom Healthcare Commercial
  • Freedom Healthcare Medicare
  • Great West Healthcare/One Health Plan of Florida, Inc.
  • Heritage Summitt W/C
  • Humana Inc.
  • Humana PFFS
  • Manatee Health Network – PPO/Aetna Your Choice
  • Medicaid-Florida
  • Medicare
  • MULTIPLAN/PHCS – PPO
  • Molina Healthcare
  • My Blue
  • Railroad Medicare
  • Simply Healthcare
  • Sunshine Healthcare
  • Three Rivers Network
  • Tricare Prime (has ins card and is HMO)
  • United Healthcare HMO
  • United Healthcare Medicarer Adv plans- all
  • United Healthcare PPO
  • Veterans Administration
  • Veterans Choice Health Net
  • Wellcare
  • Work Comp

Services may be provided in this health care facility by the facility as well as by other health care providers who may separately bill the patient, and who may or may not participate with the same health insurers or health maintenance organizations as the facility.

List of other providers includes but not limited to:

Patients and prospective patients may request from this facility and other health care providers a more personalized estimate of charges and other information. Patients and prospective patients should contact each health care practitioner who will provide services in the ASC to determine the health insurers, and health maintenance organizations, with which the health care practitioner participates as a network provider or preferred provider.

Florida Healthfinder link to locate data, including quality measures and statistics that are disseminated by AHCA pursuant to s.408.05, F.S.” is www.Floridahealthfinder.gov

PURPOSE:

To standardize the process for self pay patients

POLICY:

Self pay patients shall be given an adjustment off of the RASC fee schedule and payment arrangements will be made prior to scheduling of surgery.

PROCEDURE:
  1. When a patient is a self pay patient the billing department will determine the amount due from the patient following the formula listed below.

First CPT code – 50% adjustment of fee listed

All subsequent CPT codes – 75% adjustment of fee listed

  1. Billing Department will request full payment upon initial contact with patient.
  2. If patient able to make payment in full prior to or at time of service, an additional adjustment of 10% of total bill will be given for full payment.
  3. If patient is unable to make payment in full, payment arrangements will be made. Billing department will initially request ½ of amount due at time of service and equal monthly payments to pay balance within 6 months.
  4. If patient is unable to make payment of ½ of the amount due, then billing department will work with patient to determine an agreeable payment arrangement. If the circumstances of the payment arrangement go beyond a period of one year (12 months), then the billing department must get pre-approval from the ASC Director or the Billing Manager.
  5. Self pay pricing is based off of the Charge Master for Riverwalk ASC which is equivalent to 300% current Florida Medicare RVBS.
  6. Any written payment agreements signed by the patient that are defaulted upon can be turned over for further collections efforts by our current collection agency. Riverwalk ASC will attempt to contact patients and if there is no response, Riverwalk will begin collections process.

Riverwalk Ambulatory Surgery Center                                                               Billing, January 2012                                                                                                  1.2            

Patient will receive one statement each 30 days with a maximum of two statements. After two statements our Collection Agency will be notified and account will be transferred over to Choice Recovery to work on further collection of debt. The Agency will attempt to call and send notice to collect Riverwalk ASC debt until arrangement to pay has been agreed upon. If Choice Recovery cannot contact the patient and 45 days elapses, the patient may be sent to a major credit bureau against the patients credit.

Choice Recovery, Inc
1550 Old Henderson Rd., Ste 100
Columbus OH 43220
800-559-9277
http://www.choicerecovery.com

Accreditations & Associations
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