Insurance & Billing
At Kessler Institute for Rehabilitation (KIR), we strive to ensure that your hospital bill is processed correctly and in a timely manner.
Our Central Business Office (CBO) works with various hospital departments to gather the information needed to process your claim(s). To assist you in understanding how claims are handled, we offer the following common questions about our billing procedures and insurance coverage.
Frequently Asked Questions
I have Commercial Insurance. How are my bills processed?
If you are covered by commercial insurance, KIR will bill your commercial insurance carrier following your discharge. Your commercial insurance will send you an Explanation of Benefits summarizing the payment and your account balance. After the CBO receives the commercial insurance payment, the hospital will send your claim to your secondary insurance company (when applicable) or will send you a bill for any amount your commercial insurance states you owe. Payment is due within 30 days after your commercial insurance payment is posted. If payment or payment arrangements are not made within 60 days after your insurance pays, your account will be sent to our Extended Business Office for collection.
I have Medicare coverage. How do you bill Medicare and me?
If you are entitled to Medicare benefits at the time services are rendered, KIR will file the insurance claim to Medicare. Medicare will send you a summary notice (also know as a Remittance Advice) when they pay the hospital. This summary will show how much Medicare has paid to KIR. The summary will also show the balance you owe on your account. When KIR has posted the Medicare payment, you will receive a patient letter for any amount that Medicare states you owe. Payment is due within 30 days after the Medicare payment is posted. If you would like to make payment arrangements, please call your Patient Account Representative. If payment or payment arrangements are not made within 60 days after receiving the initial letter from KIR, your account will be sent to an outside agency for collection of the remaining balance.
I have Medicare and Commercial Insurance. How does this get billed?
If you have commercial insurance secondary to Medicare, KIR will bill Medicare following your discharge. Once Medicare has approved your claim for payment, they will send you a summary showing the amount they have paid to the hospital and the balance due. When KIR posts the Medicare payment, our Central Business Office will bill your secondary insurance company. If your secondary insurance does not pay within 45 days, we will send you a statement requesting that you contact your secondary insurance company to determine why they have not paid. Once payment is received from your secondary insurance company, a patient letter will be sent to you to advise of any outstanding amount due. This balance will be your responsibility and payment is due within 30 days. If, after 60 days, the payment is not received or payment arrangements are not made, your account will be sent to an outside agency for collection of the remaining balance.
I have Medicare and Medicaid. How are my bills processed?
If Medicaid is secondary to Medicare, KIR will bill Medicare following your discharge. Medicare will send you a summary notice when payment has been made to KIR. This Remittance Advice will show how much Medicare has paid the hospital and the balance due. The Remittance Advice is also received by the CBO and when the payment has been posted, we will bill Medicaid for the balance due. After Medicaid pays on the balance due, we appropriately resolve your balance according to Federal Guidelines. You will be sent a statement indicating patient responsibility should there be any outstanding balance after the payments are received.
I have Medicare with Non-Covered Services (ABN). How are my bills processed?
Medicare will only pay for services that it determines to be "reasonable and necessary" as stated in Section 1862 (a) (1) of the Medicare law. If Medicare determines that a particular service, although it would otherwise be covered, is "not reasonable and necessary" under the Medicare program standards, Medicare will deny payment for that service. At the time the service is to be rendered, you will be asked to sign an Advance Beneficiary Notice (ABN), which identifies the services that may not be covered and for which you may be personally and fully responsible for payment. KIR will collect these payments at the time services are rendered.
If I don't have insurance, how will you bill me?
If you are not covered by a commercial insurance, Medicare or Medicaid, you will be asked to make a deposit on your account prior to admission. A statement will be sent to you several days after you are discharged indicating the current balance due. If payment arrangements have not already been established, please contact your Patient Account Representative when you receive this statement.
Will I receive other bills?
Depending on the services you received, you may get several different bills. First, Kessler Institute for Rehabilitation will send you a bill for hospital services. There will be a separate bill from Kessler Professional Services (KPS) for those services provided by our physicians and psychologists. Please note that Kessler physicians and psychologists participate in most insurance programs; however, if they do not participate with a patient's particular insurance, the patient will be responsible for the charges incurred.
In addition, if certain tests or procedures were performed, you may receive a separate bill for professional interpretation by a radiologist, pathologist, cardiologist or other physician. Likewise, if you are transported by invalid coach, ambulance or other similar vehicle for appointments outside of the hospital, you may also receive a bill from the transportation company.
If you have any additional questions or concerns, please call our Central Business Office toll-free at 866.889.9968.