BILLINGS
& CLAIMS
Billing
Rates
To become part of the SSS Recompression Chamber Network it is
required that all affiliated hyperbaric companies have a rational
basess for their billing rates.
While Rate Standardization is not universal for SSS Affiliates,
it is very close to it. In some instances, because of deep underutilization, a certain chamber may have a special fee (or else it would be shut down).
Being a worldwide organization while at the same time adhering
to first world standards of service, maintenance, education and
training requires a set amount of capital expenditures. Recognizing
also the fixed costs (regardless of volume) in maintaining a response-ready Medical/Technical Facility (in areas where this was either
unknown, or very difficult to rely on) is a factor in rate-setting.
To ensure that quality standards are maintained and available,
and because recreational diving recompression facilities have a
low patient turnover, recompression rates are set factoring all
relevant conditions in mind. The "customary and reasonable" gets
set at a benchmark US$ or Euros per hour. The "reasonableness and customary" nature
of such rate, is something MHI helps to achieve through feedback, so long as SSS Guidelines and standards are met in the facility's
modus operandi.
Preferential
Billing
Rates
SSS Network members, through MHI, may negotiate preferential
billing rates for underwriters who produce volume over time and/or
who distinguish themselves with exemplary claims handling procedures.
There are some established preferential billing clients (assistance
companies / insurers) who receive a direct benefit in the form
of monetary savings from network members.
Claims
Processing
Medical Hyperbarics Inc. (MHI), is recommended (though not mandatory)
to be used by the SSS Recompression Chamber Network for insurance
paper handling. It is in the business
of processing medical claims for foreign (Non-US based) medical
providers and offers its affiliates a vehicle to assign to MHI
the right to process their claims for a more standardized and smoother
administration of the claim.
Many chamber affiliates are inexperienced in the processing of such claims,
focusing (as they ought to) in medical services - while MHI
and its branch have extensive experience in administering and processing
insurance claims.
MHI thus establishes contracts with some of its affiliated hyperbaric
chambers to endorse the acceptance of the claims (and undertake the collection obligations) from such Medical
Services Providers - to become the claims processor. This assignment in
the collection of claims is for specifically negotiated administrative
fees.
All Hyperbaric affiliates who request this service would assign
to MHI their interest in any claims that they may own, have an
interest in or assert a right to. This assignment includes giving
MHI the ability to file claims on behalf of the affiliate and its patients,
pursue any necessary appeals on such claims, and when necessary,
institute legal proceedings to ascertain rights under the contracted
policies.
The responsibilities of the affiliated Hyperbaric Chamber will
be to promptly assign such claims to MHI upon its receipt of
them and shall further perform all acts and conditions that are
necessary or requested by MHI to effect such assignment.
The affiliated chamber in this case will expressly agree that
MHI shall have the right to receive the assignment of such
claims and to settle such claims for such amounts as it, in its
discretion, may see fit.
MHI may also assist in the coordination of direct-pay patients
when the circumstances so dictate.
For further information on preferential billing rates contact
Medical Hyperbarics Inc. at claims@sssnetwork.com