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2000 Banks Rd., Ste. 220 Margate, FL 33063
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2024 Deductible Instructions
2024 Medicare Deductible Choices
Fields with * (asterisk) are required
Do not hold claims, invoice deductible to patient/responsible party asap.
Do not hold claims, I will deal with patients directly.
Hold claims until:
, then release all.
Call
Call once per month at $2.00/call
Call twice per month at $2.00/call
Beginning:
2024 Medicare QMB Patients
Do not hold claims, submit immediately
Reverify coverage monthly
Hold claims until:
, then release all.
2024 Patient Statement Choices:
We do not charge a fee to prepare your patient statements. We can send them to you as a PDF file at no charge. We do charge a fee, $0.65 each, if you want us to print them to paper. If you want us to print, insert into an envelope, and mail to the patient/responsible party, our fee is now $2.00 for each page. Our mailed statements include a return mailer (not postage paid) for your patients to use, very easy and professional looking.
Print
Print and send to me @ $0.65.
Print, insert and mail to patient/responsible party @ $2.00 per page.
Print to PDF files and e-mail to me for further distribution.
I will obtain statements myself from www.phybill.com.
First Name
Last Name
Email Address
Phone
Other
Contact
HIPAA Use of Patient Names:
We will not use the patient name or any other individually identifiable information on e-mails to you or any other person or entity. Sometimes it is necessary to refer to a particular pt. when communicating via e-mail, so please choose an option.
Permission
I give my permission to abbreviate the patient name, i.e.: “aldurxxx” (Alan Duretz).
Do not abbreviate or otherwise refer to a patient name in any e-mail, except only as a secure, encrypted attachment.
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