Associated Skin Care Specialists, P.A.

Dear Revdex.com: A response to the above-mentioned patient concern was sent on April 19th via fax to: *** ***, Mediation CoordinatorIt was faxed to ###-###-####Thank you

[redacted]original document attached. Thank you for your correspondence of March 30,...

2016.  We have reviewed the details in the letter, as well as the patient's medical and billing records, with regard to this particular date of service. Following is information that may shed light upon this unfortunate circumstance.  Please note that specifics are not discussed, as this would be a violation of HIPAA.The patient was seen in our office and a mid-level office visit was assessed, based on industry established guidelines regarding history, physical exam and medical decision making.  Also, during the exam the patient discussed removal of a skin tag.  Our provider would not recommend that a patient remove a lesion at home without medical supervision, doing so may cause complications.  The lesion was removed by the provider.  Again, using insurance industry standards, the claim was prepared and submitted to the patient's insurance company.The patient's insurance company processed the claim and applied the charges to the patient's co-insurance, making the outstanding balance the patient's responsibility to pay.  As a physician's office, we would not know what portion of any visit would be left to the patient until the insurance company has processed the claim.The insurance company's purported statement that we submitted the claim incorrectly does not hold true.  Some patient's as well as insurance company service representatives, are not aware that a specialty care provider is unable to bill "preventive care" under the Affordable Care Act (ACA) definition.  this is an important distinction as charges under the ACA would be covered at 100 percent.  However, those CPT Codes are only submitted by a patient's primary care provider.With regard to the collections issue, the patient was sent 4 statements between March and June, 2015.  Additionally, we mailed letters to the patient May 28, June 24, 2015 requesting response from the patient regarding payment.  We also left a message on the patient's answering machine/voice mail on June 24, 2015.  the account was forwarded to our collection agency in August, 2015.The patient made no response to attempts to contact her, with the exception of a single phone call on July 6, 2015.  During that phone call the patient stated that she had spoken with her insurance company and had been told that we need to refile the claime under preventive services through Park Nicollet.  As stated above, we do not bill under preventive care, and as we are not a Park Nicollet, we cannot bill under their name.  Our insurance specialist explained this to the patient.  She stated that she would have her insurance company call us.  No further contact was received from the patient or her insurance company.In light of the above information and our review of the account it is apparent that there may have been a miscommunication during the patient visit.  However, all codes and charges are accurate.We appreciate your time and attention to this matte,r and await your response.  Should you have any further questions, please feel free to contact me.Sincerely,Janet [redacted],Practice ManagerAssociated Skin Care Specialists[redacted]Fridley, MN 55432###-###-####