Insurance Billing FAQ

Q How does the Affordable Care Act affect college health? A The Affordability Care Act, passed March 23, 2010, includes multiple sections affecting the provision of services at campus health centers. While not fully effective until January 1, 2014, some portions became effective September 23, 2010.

Vivature Health has provided health care billing services to campus health since 2004. Vivature’s full turnkey service capabilities include health care compliance and regulatory review. Vivature is therefore well positioned to address ACA’s effects on campus health.

Below are the two primary elements of ACA affecting campus health billing:
Q Why would a college or university want to work with Vivature Health? A There are three key reasons to work with Vivature Health. Our turnkey solution will:
  1. stabilize or improve the financial status of your health center;
  2. connect with the insurance policies already held and paid for by the vast majority of your students; and
  3. create a smooth transition to the changes already brought by health care reform, as well as the additional aspects of the sweeping law that will be put in place by 2014.

If your campus health center seeks incremental dollars in your budget, without increasing either (i) the student health fee or (ii) fees for service, you should consider partnering with Vivature Health. Your students and parents will be happy that you did so now, and your school’s leadership and governing board will be pleased that you are staying ahead of the curve.
Q Our health center is currently experiencing some financial constraints; how can we pay for Vivature Health’s solution? A The short answer is that you don’t pay us a cent. We receive our revenue through a negotiated percentage of what we collect from insurance companies on your behalf. We chose this client-friendly model because we understand the challenging financial conditions faced by most health centers. Vivature Health does the work and you receive new, incremental revenue by billing insurance carriers for services you are already providing today. It may seem too good to be true, but there are no dollars paid to us out of a campus health center’s budget. Our customer service visits and software upgrades are provided to you absolutely free of charge.
Q If we bill, don’t we have to get rid of the health fee? A Definitely not. Insurance billing revenue and the health fee are not mutually exclusive. In short, insurance billing simply cannot fund your entire health center. Rather, it can serve to supplement the health fee. The health fee is needed to support infrastructure and uncompensated care, including the many wellness programs for which insurance typically does not reimburse.
Q We already have a student health fee. If we bill health insurance companies, aren’t we "double dipping"? A Not at all, but it is important to clarify what programs and services are paid for by the student health fee, and what services are paid for by health insurance. Only reimbursable professional services, such as office visits with clinicians, and certain ancillary services (such as prescription drugs and some laboratory tests) are paid for by health insurance. Everything else – keeping the health center open, your administrative and operational functions, your non-clinician staff (including nurses, medical assistants, medical records staff, etc.), health education and health promotion programs, outreach services, liaison programs with residence halls and academic departments, public health functions, information systems – is paid for by the health fee. When a health center that has not previously billed insurance plans for office visits starts doing so, it is important to communicate the change effectively with students; Vivature Health stands ready to help you do that.
Q But even if we clarify what the student health fee covers, won’t students and parents still feel like they are paying twice? A We say this with great respect, but that’s actually how students and their parents are feeling right now, absent the great end-user convenience provided by insurance billing. Today, students with private insurance visit a campus health center and are generally charged out of pocket expenses for ancillary services such as a chest x-ray, when their insurance would typically cover that service. While a student can certainly attempt to have the insurance company reimburse him or her for the chest x-ray, a series of practical barriers hampers the student from having a real opportunity to recoup his or her funds. Students and parents often inquire, generally during orientation, why campus health centers are not accepting insurance. Vivature Health not only helps campus health centers derive additional income from professional services, but we save students and parents out of pocket expenses for ancillary services such as that chest x-ray. Everybody wins.
Q What if the insurance company doesn’t pay for that x-ray? Won’t the health center lose money from that chest x-ray? A We do the necessary upfront work of placing the insurance companies that serve the lion’s share of your students in network with your health center, so the reimbursements, in the vast majority of instances, flow very smoothly to your bottom line. However, if the insurance company does not reimburse the campus health center for that x-ray, the campus health center will still have the opportunity to recoup the money from the student. This is the same procedure that would occur if that student were to visit his or her physician during the summer break; or what happens at the health center before working with Vivature Health. So why not allow us to set a mechanism for you to receive reimbursement from the insurance company rather than the student? After all, the student’s parents are paying premiums to the insurance companies.
Q Why would a college or university choose not to work with Vivature Health? A If your college health center already bills health insurance companies for all clinical services provided to students (including office visits), and consistently recover high levels of revenue without incurring disproportional administrative costs, then we have to say congratulations and we must admit that you might not benefit from Vivature Health’s medical billing services. But, of course, even health centers with such capabilities might consider working with Vivature Health because our full turnkey service produces easy, efficient, and effective third party billing. It’s what we do for a living.
Q Why would health centers that have not traditionally billed students’ health insurance plans for professional services want to start doing so? A We don’t have to tell you that financial pressures on student services have increased. You are well aware that the usual funding mechanisms of student fees or allocations of general institutional funds are no longer "elastic". At the same time, demands on health centers have also increased because of regulatory requirements, new technologies, and higher expectations from students and their parents. Billing health insurance companies for office visits and professional services is a smart move for you, and would clearly be seen as such by your internal and external stakeholders. The practical financial benefit to your health center is a new revenue stream to protect against future instability, allowing you to propose and develop new programs, and to put aside reserves for capital expenditures and emergencies.
Q Wouldn’t it be unusual for a health center to bill students’ health insurance plans? A Billing health insurance for office visits and professional clinical services is the norm in America, but such a process has been slow to catch on in college health. If you were to ask that same question to our college and university clients, they would probably term it "unusual" not to bill students’ health insurance plans. And, more importantly, your students (and their parents) are very accustomed to having their health insurance plans billed for services. After all, this is the way they have been used to consuming and paying for health care before college, and it will be the same way again after college. The standard operating procedures of health care are now only interrupted during the college years. If you move to a billing model, students will feel very comfortable as that is the system they grew up with, and the one they will continue with after graduation.
Q But won’t students be upset if we bill their health insurance plans? A Entering students will, in fact, be reassured, as will their parents. Your offer of third-party billing is exactly what these families have been used to before coming to college. And returning students will likely regard the beginning of insurance billing as evidence that the health center is becoming more mainstream – the absence of insurance billing in the past probably seemed unusual to them. Some students are currently paying out of pocket expenses for ancillary services that their insurance covers. Why charge students out of pocket dollars when their or their parent’s insurance will cover the expenses?
Q But what about confidential lab tests, including pregnancy and STIs? A The EOB (explanation of benefits) from the insurance carrier should simply state "laboratory test". However, if a student does not want to risk something private and personal appearing on his or her EOB, an alternative includes permitting the student to pay for the test in the same manner he or she pays today.
Q Will Vivature Health attempt to collect any uncollected insurance company revenue from the student? A While Vivature Health has that capability, it is unlikely that we would collect revenue from students. This is either because the campus does not "balance bill" for any uncollected amount, or because a campus can simply perform that function itself. This straightforward methodology illustrates one of the biggest differences between Vivature Health and other billing companies, who frankly are accustomed to taking a percentage of all revenue, not just insurance proceeds. Having said the above, if a campus does permit Vivature Health to balance bill, we can materially lower our percentage share of collections.
Q Won’t insurance companies oppose this? A Perhaps counter-intuitively, the answer is no. Insurance companies much prefer to pay a relatively small charge for the student who visits the health center, rather than a materially higher charge for the student who chooses to visit the local emergency room, especially for a consultation or service that could easily have been performed in your health center. Not surprisingly, students are sometimes more apt to visit a hospital, because hospitals accept insurance and campus health centers typically do not. Insurance companies prefer the more efficient cost structure of a campus health center versus a hospital, and we are happy to connect them to you in an efficient manner.
Q Some students are uninsured, or under-insured. Will the health center have to turn them away if we went to a billing model? A Absolutely not. Health centers that work with Vivature Health continue to provide appropriate care and services to all students, regardless of their ability to pay or their health insurance status. Vivature Health has processes to address uninsured students. In fact, current Vivature Health partners have found insurance billing as an opportunity to educate uninsured students about insurance.
Q Why shouldn’t we just set up our own billing system? Why do we need Vivature Health? A It is definitely possible – but also not very likely and certainly very expensive – for a health center to establish its own full-scale insurance billing operation. Given limited resources (space, personnel, funding), few health centers could reasonably invest in the staff, information systems, financial accounting services, and customer service programs required. Even fewer health centers have the administrative depth to manage credentialing, claims adjudication, negotiation with insurance carriers and other tasks. Finally, health centers simply do not have enough experience to do insurance billing effectively – and their collection rates would suffer. Working with Vivature Health solves all of these problems, and without diverting the health center’s attention away from essential student services. Why not let Vivature Health take care of your billing and software solutions, so the health center staff can focus on taking care of your students?
Q If there are local or even national companies that offer insurance billing services, shouldn’t we contract with them, instead of Vivature Health? A Vivature Health’s business is college health; we exist to help you to do your job. Our full turnkey service ensures your success, controls your risk, and makes the implementation of medical billing easy and efficient. Vivature Health is not subject to the influences and pressures that make college health a challenging market for local or national billing companies; we work with college health, and only with college health.

Vivature Health understands – far better than a local billing company would – how insurance billing in college health works, where the potential pitfalls are, and how to help you to explain it well with students and parents. By working with us, you can have full confidence that your billing operations will be managed by people who appreciate the unique features of college health programs and are sensitive to students’ special needs.
Q We are already accredited, so why would we need Vivature Health’s managed care services? A While accreditation provides added credibility to your health center in the eyes of students, the process for "credentialing" your providers with managed care organizations such as Blue Cross Blue Shield, UnitedHealth, Aetna, Humana, Cigna and others is completely separate from the "accreditation" process with AAAHC or JCAHO. Vivature Health’s managed care services include not only credentialing, but also contracting. Vivature Health’s experience in both credentialing and contracting on behalf of campus health centers results in a successful managed care experience. And once your providers become "in-network" with the large insurance carriers, it adds even more credibility to your program in the eyes of students and parents.
Q We’re not accredited by AAAHC or JCAHO. Can we still get credentialed? A Yes – AAAHC or JCAHO accreditation is not a prerequisite for getting "in-network," or credentialed, with insurance companies. And should you wish to pursue AAAHC or JCAHO accreditation, having credentialed providers should provide you with a substantial advantage.
Q Does Vivature Health understand HIPAA and HITECH regulations? How will Vivature Health protect students’ privacy? A All of Vivature Health’s policies, procedures and information technology are fully compliant with HIPAA and HITECH regulations. Vivature Health will work with you to ensure that all personal health information is handled properly and that every element of the work we do together is consistent with HIPAA requirements. Vivature Health’s Vice President of Compliance, Harold Whittington, is one of the nation’s most experienced leaders in health care regulatory compliance.
Q Will Vivature Health’s solution require us to hire additional staff members? A No. Vivature Health’s third party billing solution requires some changes operationally within the health center, but no added staff members. Vivature Health’s seamless, turnkey solution enables you to focus on providing health care to your students, while enabling Vivature Health’s billing professionals to collect new incremental revenue for your health center.
Q We already provide a statement to students to submit to their insurance company for reimbursement. Why would I work with Vivature Health? A While the intent of providing a student with claim information to send to his or her insurance company for reimbursement is well-meaning, the reality is that students rarely receive reimbursement. First, the provider doing the service is likely "out-of-network" with the student’s insurance plan. The student must then meet a higher "out-of-network" deductible. If this higher deductible is not met, the student receives no reimbursement. Second, the claim form given to students may not be coded in a format recognized by an insurance company. Further, many payors require electronic claim submission and typically deny paper claims on first submission. Finally, expecting a student to (i) research the location of the appropriate claim processing center, (ii) mail the claim, (iii) follow up with insurance company and (iv) fix any corrections in order to receive payment (assuming it’s "in-network" or deductibles have been met) is a high bar to jump. Vivature Health’s entire business is focused in the college health market; why not let Vivature Health process this transaction for you and your students?
Q My providers are out of practice in CPT coding. How much training is involved to satisfy payor documentation and coding requirements? A Our Coding and Compliance team, led by Mr. Harold Whittington, has decades of experience training providers on the thinking and practice behind insurance codes and up-to-date coding techniques. Our coding program typically consists of a few half day onsite trainings and a series of individual provider meetings. When it’s time to commence third party billing and submit claims, rest assured that your providers will be trained as well, if not better, than most providers in the private community. We encourage you to call our clients for a testimonial on the effectiveness of Vivature Health’s Coding Program.
Q If I wanted to get started today, how long would it take in order for my health center to get up and running with Vivature Health? A Vivature Health’s implementation process can take anywhere from 6 to 9 months depending on myriad factors. While preparation, training & education, technology interfacing and student marketing can be done in less time, the managed care function will take every bit of that timeframe. Before ever submitting a claim, Vivature Health urges our clients to become "in-network" providers with a majority of insurance plans that serve the student population. In order to do this on a college campus, we deploy an extremely talented team with contacts and experience in college health and in the insurance industry. Rest assured that Vivature Health has the experience to solve the managed care issues in college health – just ask our clients.
Q Does Vivature Health outsource college health programs? A No. Vivature Health provides specific services and assistance to college health centers. Vivature Health does not outsource or manage college health centers.
Q What qualifications does Vivature’s medical billing team have? A Click here to view our team’s bios.
Q What if we like our current software but still want to bill private health insurance? A While we’d love for you to switch to our Vivature suite of products — as we think you'll like both the products and the eliminiation of the maintenance payments — we understand that you may like and want to keep what you have. If you want to keep your current system but still want to bill private health insurance, that’s not a problem. After all, we did that with every client before we completed our own software development. We’ll just interface with your current vendor.
Q Will the percentage of collections be less if we don’t use your software? A No. In fact, your percentage of collections will be higher if you use Vivature. We gain significant synergies when our clients use one system. The revenue collections will necessarily be lower, and receipts slower, interfacing with another vendor. Plus, we incur other expenses that we don’t incur if you use our system. And according to an industry report from Triple Tree Advisors, the industry — for efficiency reasons — is moving in the direction of private practices using a consolidated software and billing solution.