Understanding the world of Medicare and Medicare processes is a topic for possibly endless discussion and opportunity for learning. In my last post about the decision making process for contracting with commercial carriers, I mentioned that I would talk about what it means to contract with Medicare – and here we are.
The decision to contract with commercial insurance companies or remain strictly fee-for-service with your patients is one that will have an enormous impact on your administrative flow and needs within your practice. There are pros and cons to contracting, and we’ll take a look at both sides in this discussion.
If you are a mental health provider practicing in Wisconsin and you are contracted with BlueCross BlueShield (BCBS), what do you do when and a patient walks into your office with their BCBS of Texas insurance card? Are you considered “in-network,” “contracted,” “participating,” or any other term that means the patient has chosen a doctor their insurance will recognize? If you bill their insurance, do you have to accept the allowed amount? Can you still send your insurance claims to the same BCBS office in Wisconsin that you always use?