Information for Patients

1. Who is QFA?

The purpose of Quality First Assist, LLC is to provide a comprehensive reimbursement program founded in accordance with current Centers for Medicare and Medicaid Services Policies. We will achieve this through open communication between our Staff and the Clients as well as the Insurance Payer. We will follow CMS guidelines and Provide continued education workshops to facilitate and promote ethical and legal conduct. We are motivated to the highest industry work ethics by providing and ongoing process of improving operations through employee involvement. Our staff here at Quality First Assist, LLC Management is committed to a level of superior services and internal audits conducted by Quality First Assist managers. We will provide ethical leadership to assure excellence in operations that exceeds the expectations of the client.

2. What is a Surgical Assistant?

A Surgical Assistant is a highly skilled individual, providing quality peri-operative care to patients, who has received specialty training in surgical assisting through:

 Physicians and/or surgeons

 Formal training in surgical assisting form universities, hospitals, private schools, allied health organization programs

 Military training in specialty programs, operating rooms and in the field

 Foreign medical school graduates working in the United States with proper national certification.

 Hospital operating room staff members trained by surgeons in the operating room (registered nurses, physician assistants)
A Surgical Assistant should not be confused with a “Surgical Technician”, a surgical tech is the member of the OR team provided by the facility to hand out instruments to the surgeon and his/her assistant during the operation

3. Why am I getting a bill from you?

As stated above, we are contracted by the Surgical Assistant in your surgery to submit the medical claim, after reviewing the claim, your insurance company has determined that you are responsible for the amount in your statement, your payment should be made to us, and we will forward your payment to him/her in a timely fashion.

4. Why did my surgeon utilize a Surgical Assistant?

After thoroughly reviewing your medical history and the surgical procedure that was to be performed, your surgeon determined that a Surgical Assistant was medically necessary.

5. Why didn’t my surgeon tell me he was going to use a Surgical Assistant?

The decision of what to discuss with the patient prior to surgery is a personal matter between the surgeon and the patient. Many surgeons advise their patients prior to surgery. However, some surgeons do not wish to burden their patients with any additional information that they feel would not be vitally important for their patient’s impending surgery and recovery. Your surgeon made many similar pre-operative decisions, such as choices of anesthesia, type if instruments, surgical supplies to use, which he or she may or may not have discussed with you prior to your surgery.

6. Why did my surgeon use a provider not in my network?

Unfortunately, most surgical assistants are not participants in every PPO and HMO at this time, and this is due mainly because insurance companies do not want to accept them as providers. Being this said, if your insurance company does not contract with surgical assistants in your area, you can appeal their determination and most plans will cover these services if in fact they do not have any surgical assistants in their network because obviously this is not your fault/ However at this moment the only person that can make this appeal to the insurance is you as their member.

7. My insurance said that a Surgical Assistant was not medically necessary.

Insurance companies often make their determination of medical necessity on the basis of their overall average experience with many surgeons and many patients over a period of time, rather than on a specific individual patient’s situation. In any event, the use of a surgical assistant is always at the discretion of the surgeon. In your particular case, your surgeon felt that an assistant was medically necessary. 8. Why is my insurance company not covering the services of a Surgical Assistant? Each insurance company and each individual plan has their own itemized list of covered benefits and non-covered items, most insurance companies do cover the charges for a surgical assistant. You may wish to review your individual insurance plan policy and discuss the exclusion of this particular service with a representative of your insurance carrier, your employee benefits administrator, your human resources manage, or your employer, as appropriate.

9. Will you file a review or appeal to my insurance company if the charges are denied?

Yes. We regularly perform this service as a courtesy to our referring providers and their patients. However, we cannot guarantee that your insurance carrier will change their payment determination. If you already have received a statement, this means that all appeal efforts have been exhausted with your insurance provider.

10. Can I make payment arrangements?

Yes, certainly. Please call our office (682) 238-3507 to make payment arrangements. We can work with you to arrive at a comfortable budget for you.

11. Why do I have to pay for a surgical assistant when I did not authorize this?

Since my surgeon is the one who asked this individual to provide the service, he or she should pay for it. The hospital policy regarding this is stated on the surgical consent form. This for explains that certified surgical assistants may be called to help with an operation. The need for an assistant cannot always be predicted. When you selected your surgeon, you relied upon his or her good judgement and skill to make decisions that were in the best interest of your health and will-being. There are many decisions that your surgeon made on your behalf in the process leading up to your surgery, the actual performance of your surgery, and the immediate recovery period following your surgery. As a practical matter, your surgeon was unable to discuss each of these decisions with you, the patient. After thoroughly reviewing your medical history and the surgical procedure that was to be performed, your surgeon determined that it was in your best interest for the safest possible performance of your surgery to have a surgical assistant present during you surgery. This would be similar to asking to pay for any anesthesia or medications that were not authorized by you.

12. Did you bill my insurance?

We usually receive insurance from the hospital where you had your surgery directly from your provider. If the information is complete, we will use that information to send a claim to your insurance carrier. If you wish to verify that the information we have is accurate & complete, please fill out the back of the stub that came with your bill giving us full insurance information, including your identification number, your group number, and the name of the insured person and his or her date of birth. It is very helpful to send us a photocopy of the front and back of your insurance card. This way, if we do not have complete and accurate information, we can promptly correct our files, submit a claim to your insurance carrier in a timely manner, and avoid any delays in the payment of your bill.

THE PROCESS

1. Submit all the patient demographics and all related documentation to be able to submit the claim.

2. We process and send the claim within 72 hours of received complete documentation

3. We wait 60-90 days for response from payors. 4. Request any documentation requested or to settle will be handled appropriately.

5. If no response from payor within 90 days, we will begin the follow up process with the payor.

6. Any denial that deems an appeal, will be appealed appropriately and in a timely fashion. (Not all appeals are appealable)

7. Once we receive payment from the primary payors, all secondary payors will be billed if necessary.

8. If no secondary payor is on file, we will close the account (Patient billing will be on a client by client basis)

9. Reimbursement checks received will be submitted to you electronically. Biweekly if amount is less than $1000.00, if the amount is more than $1000.00 checks will be submitted once a week.

10. Because we submit your claims with your information and your W9, all checks will come to your name, Quality First Assist LLC does not have access to your funds whatsoever.

11. At the end of the month we will invoice you for our fee, payable on the 10th of each month.