Medical Billing Forum
Payments => Insurance Payments => : scgs52 March 26, 2009, 04:14:00 PM
-
I work for an opthalmology practice that has an optical department. Our optical shares a tax ID # with the physicians. If a patient purchases glasses from our optical department and we bill their insurance who then in turn processes the claim for payment and applis a contractual write off are we required to do the adjustment? I have been told that since only our physicians participate with the insurance and not the optical department we do not have to do the adjustment. My thoughts are since the optical department has the same tax id as the MD's this also makes them particpants with the insurance therefore requiring them to have to take the write off? Any thoughts on this?
-
If you are billing under the same tax ID then you are considered one entity, and therefore you are either all participating, or all not participating. It isn't possible for the dr's to be in network but the optical part not (at least in my part of the country). We actually bill for a couple of groups like yours, where the dr's are one 'side' and the optical department is the other, but as far as insurance companies are concerned they are one group. If the group is par, then you have to honor the contractual adjustment.
Michele
-
If you are billing under the same tax ID then you are considered one entity, and therefore you are either all participating, or all not participating. It isn't possible for the dr's to be in network but the optical part not (at least in my part of the country). We actually bill for a couple of groups like yours, where the dr's are one 'side' and the optical department is the other, but as far as insurance companies are concerned they are one group. If the group is par, then you have to honor the contractual adjustment.
Michele
I agree. Its all under 1 tax ID