A: Yes and no. We only pursue Medicare reimbursement and then private secondary insurance when the primary insurance is Medicare. If a patient has only private pay, we do not pursue those claims.
The outliers beyond Medicare which are workers’ compensation and personal injury. These claims which we refer to as whales can be $50K and more in size but take substantially more investment in time and overhead. Due to the upfront investment, we only recommend taking on a few of those cases annually. Additionally, the whale case is best for those clinicians who are detailed masters. Documentation for these claims requires the most detail of any clinical work. If you are in this category of attention to detail and are billing a reasonable volume of Medicare Part B claims, we can talk further about the approach to pursuing these patients and claims.