Payments > Patient Billing
HELP PLEASE! Primary/Secondary and Patient Responsibility
Chiro Billing Collect:
Thank you. I purchased the manual. This way was closest to how I have been calculating patient responsibility up to this point. It does, however, conflict with the statements above that both contracts must be honored. If that were the case, then patient would have $0 patient responsibility.
When I calculate with higher allowable as stated in the manual, the patient is responsible for a balance.
I am still unsure as to which is the correct answer but appreciate both of your answers.
PMRNC:
--- Quote ---In other words, when calculating patient responsibility, basically use the lower of the 2 fee schedules minus what both insurances paid to find the total. Is that correct?
--- End quote ---
Yes, I had an idea it would.
--- Quote ---This is what I'm looking at: BCBS (primary): Allowable $45 (went towards deductible) - Patient Responsibility $85 - Paid $0
1199-Aetna (secondary): Allowable $35 - Patient Responsibility $0 - Paid $35.
--- End quote ---
You did not include the total charges, and in your example the allowable from primary was $45 but patient responsibility was $85 and your secondary allowable was $35 with them paying $35 . The patient responsibility from primary carrier of $85 is throwing me as the allowable's from both are so way UNDER that I can't really determine anything w/out knowing the actual charges.
Chiro Billing Collect:
BCBS lists charges which should actually be adjusted off as patient responsibility which is why the PR was greater than the allowable. I am not sure why they have been doing this on our EOR's as we are participating but I am going to disregard that and adjust it off. Here is what it should be:
BCBS (primary): Total charges $115 - Allowable $45 - (went towards deductible)- Patient responsibility - $45 - Paid $0 <Benefits include $500 deduct which isn't met and $45 max per visit>
Aetna (1199-secondary): Allowable $35 - Patient responsibility $0 - Paid $35 <Benefits include $0 deduct $0 copay>
According to your method, the patient would owe $10 I believe. If I was to honor both contracts or follow the lower fee schedule, the patient would $0.
PMRNC:
--- Quote ---BCBS lists charges which should actually be adjusted off as patient responsibility which is why the PR was greater than the allowable. I am not sure why they have been doing this on our EOR's as we are participating but I am going to disregard that and adjust it off. Here is what it should be:
BCBS (primary): Total charges $115 - Allowable $45 - (went towards deductible)- Patient responsibility - $45 - Paid $0 <Benefits include $500 deduct which isn't met and $45 max per visit>
Aetna (1199-secondary): Allowable $35 - Patient responsibility $0 - Paid $35 <Benefits include $0 deduct $0 copay>
According to your method, the patient would owe $10 I believe. If I was to honor both contracts or follow the lower fee schedule, the patient would $0.
--- End quote ---
BINGO.. you got it. :)
BUT.. on a side note.. I really want to know why of $115 the primary only allowed $45.
Michele:
--- Quote from: PMRNC on October 16, 2017, 05:34:53 PM ---
--- Quote ---
According to your method, the patient would owe $10 I believe. If I was to honor both contracts or follow the lower fee schedule, the patient would $0.
--- End quote ---
BINGO.. you got it. :)
--- End quote ---
So now I'm confused.....which is correct?
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