Notifications
Notices and Declarations
The content of this site is for informational purposes only and should not be considered professional medical advice. For personal medical care you should see a qualified medical professional who can perform appropriate diagnostic exams and tests and provide a treatment plan. We would be happy to partner with you in your foot and ankle care.
Thank you for choosing us as your health care provider. We are committed to your treatment being successful and payment of your bill is considered a part of your treatment.
The following is a statement of our Financial Policy which we require you read and sign prior to any treatment. We understand that many patients find financial matters surrounding their medical care to be very complex and often confusing. If you ever have a question regarding our billing policies, we will be happy to assist you.
Insurance: We will bill your insurance as a courtesy. We cannot bill your insurance company unless you give us complete and correct information. Your account balance is your responsibility, whether your insurance company pays or not. Your insurance policy is a contract between you and your insurance company. We are not a party to that contract. In the event we do accept assignment of benefits, we want you to be aware that you are responsible for your account balance. If your insurance company has not made payment on your account within 30 days, the balance will become your responsibility and late fees/liquidated damages may be charged for all unpaid balances at 1% per month (12% annually). We will balance bill you for any unpaid balances after your insurance makes payment. Please be aware that your insurance may determine that some, or perhaps all, the services provided for office visits or surgery are not covered under your insurance plan. Whether or not these procedures are allowed or denied by your insurance company you will be responsible for the final balance. All insurance co-payments and deductibles are due at the time of service.
Collections: If your account is sent to a collection agency for non-payment, the collection agency will charge you fees and interest on any unpaid balance and we will no longer be available to provide treatment for you.
We are currently contracted, and a preferred In-Network provider, with Aetna, First Choice Health Network, Medicare, Medicaid, Tricare, and the VA. We accept all other insurance providers. Generally, Medicaid statutorily excludes coverage of podiatric services after the age of 21.
Out-of-Network Patients: A $500 deposit is required before each appointment and will be applied to your visit. Your insurance carrier(s) will be billed as a courtesy. We will send you an invoice for any remaining balance. After payment has been received from your insurance carrier if there is any excess remaining from your deposit this will be refunded.
Self-Pay Patients: A $500 deposit is required before each appointment and will be applied to your visit. Any additional charges will be collected on the same day. A 20% discount applies to same-day payments if the account is paid in full. Any overpayment from the deposit will be refunded.
Motor Vehicle Accidents: A claim must be established with your auto insurance carrier. We will only bill first party claims (your auto insurances / policy) regardless of faults. Once your medical benefits are exhausted, your private insurance may be billed. YOU MUST CONTACT YOUR PRIVATE INSURANCE TO DISCLOSE YOUR LIABILITY CLAIM. If you have no other insurance coverage, your account will be transferred to a self-pay status and payment will be due upon receipt unless other billing arrangements have been approved by the Billing Department.
Payment is due in full at the time of service unless other billing arrangements have been approved by the Billing Department. If your account is sent to a collection agency for non-payment, the collection agency will charge you fees and interest on any unpaid balance and we will no longer be available to provide treatment to you.
Usual and Customary Rates: Our practice is committed to providing the best treatment for our patients, and we charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company’s arbitrary determination of rates and fees.
Adult Patients: Adult patients are responsible for payment of deductibles and co-payments at the time of service.
Minor Patients: The adult accompanying a minor and the parents (or guardians of the minor) are responsible for payment of deductibles and co-payments at the time of service.
Missed Appointments: We reserve the right to charge a $25.00 fee for missed appointments unless they are canceled 24 hours in advance. Your insurance will not pay this fee and you will be responsible. Please help us serve you better by keeping your scheduled appointments. We reserve the right to dismiss patients from the practice for chronic missed appointments.
Payment Plans: Payment plans must be established with our clinic prior to checkout. Payment plans are based on a maximum number of six months from the date services are rendered. Once you have reached the maximum length of the payment plan, you must obtain alternative financing. All payments received are applied to your oldest services first.
Chugach Sports Foot and Ankle uses ambient AI scribes to help streamline your patient visit. The biggest administrative burden medical providers face is creating a note documenting each patient visit. AI scribes are designed to assist healthcare professionals and improve efficiency and accuracy in documenting your patient visit.
Without an AI scribe, most clinicians will need to divert their attention away from the patient so they can type information into the electronic health record (EHR) to generate the encounter note. The physician is not fully focused on the patient, rather they are multi-tasking and trying to simultaneously achieve regulatory compliance in documenting your visit and include important information about your medical history and current concerns.
When clinicians use an AI scribe, the application listens in the background, transcribing the conversation between the doctor and patient. The AI scribe uses this transcription to create a summary of the discussion and accurately create a note with the required information. Using ambient AI allows clinicians to be more fully present with you, giving you their full and undivided attention. We believe this improves patient care and enhances your experience while in the clinic at Chugach Sports Foot and Ankle.
After your visit this summary is then reviewed by the physician, edited, and additional information and insights are added. Generating documentation in near real time is very helpful in limiting physician burnout.
The ambient AI scribe is not dictating your care or choosing treatment options for you. The ambient AI service is secure, and HIPPA compliant. After generating the encounter transcription the ambient AI voice recording data is deleted.
If you do not consent to your physician using ambient AI during your visit, inform them of your wishes and they will be honored.
We will treat you without regard to your race, nationality, religion, beliefs, age, disability, sex, sexual orientation, gender identity or expression.
Privacy Practices (HIPAA)
We are committed to protecting the privacy of your protected health information (PHI) and will only use or disclose your medical data as permitted by law. You have the right to access your medical records and request restrictions on how your information is shared; please review our full Notice of Privacy Practices for details on how we handle your health information.
Notice of Privacy Practices
Protected Health Information (PHI)
Your health information is kept strictly confidential, and it not released without your consent. Protected Health Information (PHI) is information that individually identifies you and that we create or get from you or from another health care provider, health plan, your employer, or a health care clearinghouse and that relates to (1) your past, present, or future physical or mental health or conditions, (2) the provision of health care to you, or (3) the past, present, or future payment for your health care. This may include demographic information, medical history, diagnoses, treatment plans, medications, and billing details
Purpose of collecting data
This protected health information may be disclosed in several ways, including for providing treatment, processing payments, and managing healthcare operations without additional authorization. Other potential uses and disclosures as required by law may include to parents of minors, business associates, lawsuits or disputes, governmental agencies, and as legally required.
Medical Record
Your medical record can be accessed and requested through the patient portal.
or
Fill out and sign the authorization for Use and Disclosure of Protected Health Information and fax the completed document to:
Fax: 907-931-9946
Chugach Sports Foot and Ankle, LLC
Phone: 907-931-1726
All Medicare DMEPOS suppliers must be in compliance with these Supplier Standards in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R. pt. 424, sec 424.57(c) and went into effect December 11, 2000. A supplier must disclose these standards to all customers/patients who are Medicare beneficiaries (standard 16). A shortened version has been created to help suppliers comply with this requirement.
(1) Operates its business and furnishes Medicare-covered items in compliance with all applicable Federal and State licensure and
regulatory requirements;
(2) Has not made, or caused to be made, any false statement or misrepresentation of a material fact on its application for billing
privileges. (The supplier must provide complete and accurate information in response to questions on its application for billing
privileges. The supplier must report to CMS any changes in information supplied on the application within 30 days of the change.);
(3) Must have the application for billing privileges signed by an individual whose signature binds a supplier;
(4) Fills orders, frabicates, or fits items from its own inventory or by contracting with other companies for the purchase of items
necessary to fill the order. If it does, it must provide, upon request, copies of contracts or other documentation showing compliance
with this standard. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State
health care programs, or from any other Federal Government Executive Branch procurement or nonprocurement program or
activity;
(5) Advises beneficiaries that they may either rent or purchase inexpensive or routinely purchased durable medical equipment, and
of the purchase option for capped rental durable medical equipment, as defined in §414.220(a) of this subchapter. (The supplier
must provide, upon request, documentation that it has provided beneficiaries with this information, in the form of copies of letters,
logs, or signed notices.);
(6) Honors all warranties expressed and implied under applicable State law. A supplier must not charge the beneficiary or the
Medicare program for the repair or replacement of Medicare covered items or for services covered under warranty. This standard
applies to all purchased and rented items, including capped rental items, as described in §414.229 of this subchapter. The supplier
must provide, upon request, documentation that it has provided beneficiaries with information about Medicare covered items
covered under warranty, in the form of copies of letters, logs, or signed notices;
(7) Maintains a physical facility on an appropriate site. The physical facility must contain space for storing business records
including the supplier’s delivery, maintenance, and beneficiary communication records. For purposes of this standard, a post office
box or commercial mailbox is not considered a physical facility. In the case of a multi-site supplier, records may be maintained at a
centralized location;
(8) Permits CMS, or its agents to conduct on-site inspections to ascertain supplier compliance with the requirements of this section.
The supplier location must be accessible during reasonable business hours to beneficiaries and to CMS, and must maintain a
visible sign and posted hours of operation;
(9) Maintains a primary business telephone listed under the name of the business locally or toll-free for beneficiaries. The supplier
must furnish information to beneficiaries at the time of delivery of items on how the beneficiary can contact the supplier by
telephone. The exclusive use of a beeper number, answering service, pager, facsimile machine, car phone, or an answering
machine may not be used as the primary business telephone for purposes of this regulation;
(10) Has a comprehensive liability insurance policy in the amount of at least $300,000 that covers both the supplier’s place of
business and all customers and employees of the supplier. In the case of a supplier that manufactures its own items, this insurance
must also cover product liability and completed operations. Failure to maintain required insurance at all times will result in
revocation of the supplier’s billing privileges retroactive to the date the insurance lapsed;
(11) Must agree not to contact a beneficiary by telephone when supplying a Medicare-covered item unless one of the following
applies:
(i) The individual has given written permission to the supplier to contact them by telephone concerning the furnishing of a Medicare-covered
item that is to be rented or purchased.
(ii) The supplier has furnished a Medicare-covered item to the individual and the supplier is contacting the individual to coordinate
the delivery of the item.
(iii) If the contact concerns the furnishing of a Medicare-covered item other than a covered item already furnished to the individual,
the supplier has furnished at least one covered item to the individual during the 15-month period preceding the date on which the
supplier makes such contact.
(12) Must be responsible for the delivery of Medicare covered items to beneficiaries and maintain proof of delivery. (The supplier
must document that it or another qualified party has at an appropriate time, provided beneficiaries with necessary information and
instructions on how to use Medicare-covered items safely and effectively);
(13) Must answer questions and respond to complaints a beneficiary has about the Medicare-covered item that was sold or rented.
A supplier must refer beneficiaries with Medicare questions to the appropriate carrier. A supplier must maintain documentation of
contacts with beneficiaries regarding complaints or questions;
(14) Must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered
items it has rented to beneficiaries. The item must function as required and intended after being repaired or replaced;
(15) Must accept returns from beneficiaries of substandard (less than full quality for the particular item or unsuitable items,
inappropriate for the beneficiary at the time it was fitted and rented or sold);
(16) Must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item;
(17) Must comply with the disclosure provisions in §420.206 of this subchapter;
(18) Must not convey or reassign a supplier number;
(19) Must have a complaint resolution protocol to address beneficiary complaints that relate to supplier standards in paragraph (c) of
this section and keep written complaints, related correspondence and any notes of actions taken in response to written and oral
complaints. Failure to maintain such information may be considered evidence that supplier standards have not been met. (This
information must be kept at its physical facility and made available to CMS, upon request.);
(20) Must maintain the following information on all written and oral beneficiary complaints, including telephone complaints, it
receives:
(i) The name, address, telephone number, and health insurance claim number of the beneficiary.
(ii) A summary of the complaint; the date it was received; the name of the person receiving the complaint, and a summary of actions
taken to resolve the complaint.
(iii) If an investigation was not conducted, the name of the person making the decision and the reason for the decision.
(21) Provides to CMS, upon request, any information required by the Medicare statute and implementing regulations.
(22) All suppliers of DMEPOS and other items and services must be accredited by a CMS-approved accreditation organization in
order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which
the supplier is accredited in order for the supplier to receive payment for those specific products and services.
(23) All DMEPOS suppliers must notify their accreditation organization when a new DMEPOS location is opened. The accreditation
organization may accredit the new supplier location for three months after it is operational without requiring a new site visit.
(24) All DMEPOS supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be
separately accredited in order to bill Medicare. An accredited supplier may be denied enrollment or their enrollment may be
revoked, if CMS determines that they are not in compliance with the DMEPOS quality standards.
(25) All DMEPOS suppliers must disclose upon enrollment all products and services, including the addition of new product lines for
which they are seeking accreditation. If a new product line is added after enrollment, the DMEPOS supplier will be responsible for
notifying the accrediting body of the new product so that the DMEPOS supplier can be re-surveyed and accredited for these new
products.