Practice Management Alert

* the party at fault

* medical payment funds available on policies

* your relationship with the insurer

* the agent or attorney involved

* the patient's track record of payment to your office

* the seriousness of injuries

* the patient's financial situation.

If you're working for an orthopedic practice, pay special attention to assessing your auto insurance claims. Because orthopedics receives almost all motor vehicle accident (MVA) patients, whether or not you get paid from auto insurance claims is a "big issue" for that specialty, Sosebee says.

It's tempting to kick energy-guzzling auto insurance claims out the door, but savvy personal skills may be your ticket to getting paid from them.

If you decide to bill the automobile insurance, "make sure you know whom you are dealing with," Sosebee says. Build the right relationships with both auto insurers and third-party payers. Develop strong relationships with the agent, the insurer's claims department, and the attorney, she advises. Sending medical records promptly, when requested, is one way to improve business relations. (For more tips, see the companion article in article 2.)

Getting to know the agent "worked out well" for her office, says Paula Casto, billing manager at Teen & Family Care in Irving, Texas. When Casto billed the patient's PIP plan the Personal Injury Protection Benefits contained within an automobile insurance policy the agent allowed her to fax the claims, and she was paid within the week.

Work with the claims adjusters as well. Bill auto insurance when a claims adjuster calls, experts tell Medical Office Billing and Collections Alert. If the claims adjuster asks for the medical claims form in exchange for pay, consider giving him the claim you've already filed to medical insurance and reimbursing the medical insurer.

But regardless of the circumstance, when you bill auto insurance, you make a potentially hazardous move. "When all is said and done, it really is a risk the biller takes," Sosebee says. You may not get paid, timely or fully, and often the claims involve complicated technical and legal problems that have nothing to do with you.

To ensure your physicians receive timely payment, sometimes you have to pass on billing auto insurance.

Avoid billing auto insurance if it involves two people's insurances, Sosebee says. Otherwise, you're likely to face lengthy lawsuits over who gets paid and who's at fault, she warns. Billing auto insurance when only one patient is involved and only one auto insurance is handled is "the only way I would ever consider billing an auto insurance," she says.

When deciding whether to bill auto insurance instead of health insurance, don't be fooled by the auto insurance's numbers. Even though the reimbursement from health insurance is often lower than from auto insurance, "if you calculate the time and manpower used, the rate is not any better," experts warn.

If billing auto insurance siphons too much of your resources, leave the bill instead to patient responsibility, with the understanding that the patient will pay at a specified time. Tell the patients up front your policy on auto insurance claims and then treat them like any other self-pay patients, Sosebee says. Offer the patients copies of their payments so they can seek reimbursement from auto insurers separately, she suggests. If the charge is extremely high, offer a payment arrangement based on the patient's balance and financial situation.