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UWHC,UWMF,

Patient Services,Business,

Departments & Programs,UW Health

Billing

Billing - Departments & Programs, UW Health

The Billing Operations Department has responsibility for oversight of the HIPAA Transaction Code Sets which allows our Organization to move large volumes of electronic billing data to Insurance Carriers and receive responses.


Focus

The Billing Operations Department consists of the Claims, Training, Scanning Team, PBS Mail Room and the Payment Posting team. Allison Gasser is the manager and may be reached at (608) 828-1811. Billing department responsibilities are listed below.

Claims, Training and Scanning

The Claims department is responsible for ensuring the timely filing of claims. Electronic claims are compiled to files and transmitted to payers directly or through a clearinghouse. This department verifies via electronic acknowledgment that payers have received complete files. They retrieve pre-process error reports from the payers and resolve the errors to re-send clean claims. The department also handles all paper claim submission from production of the claims to attaching required documentation to support the claim as well as the actual mailing of the claims to the correct payers. Eighty-five percent of all UWMF claims are sent to payers electronically.

The supervisor of this department provides training to PBS and DFM staff in Epic Resolute and works with all PBS and clinic staff on Epic billing questions. Document scanning also resides within this department. Liz Schoenknecht is the supervisor and may be reached at (608) 829-5240.

Payment Posting

The Payment Posting department is responsible for posting payments, both electronically and manually to patient accounts. Eighty-five percent of all UWMF payments are posted electronically. The payments are received from insurance companies as well as patients. This team is also responsible for posting insurance company denials to the patient accounts, the reconciliation of the electronic payment batches, the manual posting of payments that appear on error reports and for posting all refunds and NSF check transactions. Jane Schmidt is the supervisor and may be reached at (608) 829-5243.

FAQ

How is the hospital telling its patients about Facility Fees?

There are signs in all registration areas at clinics where Facility Fees are charged. This information is
also contained in a brochure about our billing practices, which is included in a packet given to all new
patients. Staff in our billing office is available to answer patient questions, and we are providing
registration and other clinic staff with similar information that can be given to patients to help explain
these fees.

How much is a visit going to cost?

It can be hard to know ahead of time exactly how much you’ll be charged for a visit. Charges are based
on such things as time spent with the clinician, services ordered, diagnoses associated with those
services, and supplies that are used. To help our patients, UW Health offers an estimate service called
Priceline. You may call the UW Health Priceline at (608) 263‐1507 and ask for a price estimate for procedures, tests and any other related fees. While we try to give our patients the most accurate information, the estimate may be higher or lower than the actual charges. 

How do I know if my insurance company will cover the Facility Fee?

Most insurers do cover facility fees, but some do not. Before your visit, take the time to call the
customer service number listed on your insurance card to find out if your plan covers facility fees billed
by hospital‐owned clinics.

How do I figure out how much to put into my flex spending account for next year?

Usually the best way to determine how much to contribute is to make a list of expected out‐of‐pocket
medical expenses for you and your dependents for the next year and compare it to your benefits for
next year. You also have the option of contacting your insurance company for last year’s records or
asking all your healthcare providers for a statement(s) of past charges to review against your benefits
for the upcoming year. Most flex plans have administrators that can assist with this process.

I have new insurance. How will I know what my benefits will be next year?

Because of variation among insurance plans, you should get this information directly from your health
insurance company, which is required to provide this information to you. Check your insurance card for
the appropriate number to call.

I see two services billed during my physical. Does this mean I will have to pay for two visits or services for the same date?

Yes, however, while you are billed for both services, your charges for each are reduced so that the total
amount billed is the same. The fee for the physical exam is reduced by the amount of the office visit.
However, if the office visit fee is more than the physical fee, the physical is not charged. This pricing
method was set up by Medicare. Because Medicare does not normally cover a preventive service visit,
this pricing method reduces the out‐of‐pocket cost of the preventive service visit for Medicare patients.
Even though only Medicare requires this pricing method, UW Health Physicians extends this savings to
all patients.

What is a Facility Fee and what does it cover?

Facility fees represent all the costs of operating a building for health care delivery except the doctors’
professional fees. They cover the costs of equipment, utilities, maintenance, supplies and medications
administered during a clinic visit. They also pay for care by non‐physician staff such as nurses,
pharmacists, social workers, medical assistants, respiratory therapists, and dieticians.
Because hospital‐owned (UW Hospital and Clinics) clinics are required to meet strict patient safety
standards and more regulatory requirements than physician‐owned practices, facility fees also help to
offset the cost of meeting these mandated requirements. Finally, fees also reflect some of the cost of training of physicians, nurses, pharmacists and other health
care professionals.

Why are two services billed during my physical?

A physical (also called a “preventive medicine visit”) is a medical exam geared for the age and gender of the patient. It includes services to prevent or screen for illness, such as immunizations and health
assessment. A preventive medicine exam does not include assessment of a new or existing condition.
When a new or existing condition is identified and addressed during a preventive medicine visit,
industry billing guidelines require that a separate office visit be billed.

Why is a Facility Fee charged at UWHC clinics but not at UWMF clinics? Aren’t you all part of UW Health?

When clinics are doctor‐owned and operated, they are able to charge patients a single fee that includes
all the costs associated with running their practice. When clinics are hospital‐owned, there must be two
separate bills, one from the medical group for the doctor’s professional fees and the other from the
hospital for all other costs. This second bill is referred to as the “facility fee.”

Will my insurance cover the charges for two visits or services?

We suggest you ask your insurer whether your policy covers these services before you come to your
physical. Even if both the office visit and physical are covered by your insurance, you may have out‐ofpocket costs for co‐pays, coinsurance, or deductibles. Please know that our pricing policy is intended to limit your out‐of‐pocket expense when both services are provided during the same visit.

Will the Facility Fee always be the same amount?

Facility Fees vary depending on how much time patients spend with their caregiver(s) and how much
equipment is involved in their care. Fees can be higher at specialty clinics such as otolaryngology,
ophthalmology, where specialized equipment and services can be more costly.

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