Discounted Rate to Insurance

[platmedrec1]

I got this email from my doc today:

We have a patient that we have a financial hardship agreement signed with, 20.00 per adjustment. Can we bill the insurance for that reduced rate of 20.00 as long as that is what the patient is paying and is there a mod that we can/need to put on the code that shows it is a reduced rate and not our usual and customary rate?

I don't have any experience billing insurance companies reduced rates and I am wondering if we would use the -52 modifier?  Technically, we aren't reducing services, but only the fee, but I can't seem to find another modifier or if I need to use one at all.  I just wanted to have some kind of paper trail so it doesn't look like we are billing different insurances differnent fees.

Thanks!
Cara

[PMRNC]

I got this email from my doc today:

We have a patient that we have a financial hardship agreement signed with, 20.00 per adjustment. Can we bill the insurance for that reduced rate of 20.00 as long as that is what the patient is paying and is there a mod that we can/need to put on the code that shows it is a reduced rate and not our usual and customary rate?

I don't have any experience billing insurance companies reduced rates and I am wondering if we would use the -52 modifier?  Technically, we aren't reducing services, but only the fee, but I can't seem to find another modifier or if I need to use one at all.  I just wanted to have some kind of paper trail so it doesn't look like we are billing different insurances differnent fees.

Thanks!

NO NO.. and NO.
Would it make sense that you have discounted that fee that you should get it from the carrier? That's just as wrong as billing the patient's next door neighbor.  Actually and legally you must submit the bill to SHOW the discount because the insurance carrier has a right to the same discount you give the patient, after all the patient is in violation of the cost-sharing obligation/contract between them and their carrier.

For example:   Charge is $100   Patient pays $20, Balance due is $80.00   Claim has to be submitted with full charge of $100, patient payment of $20 (or discount)

Yes you are still going to have a balance in your A/R, that you will adjust off as a write off. It's good that you have a financial hardship on file to cover yourself, but still the discount must be given to the carrier.

[platmedrec1]

OK that is what I was trying to figure out.  I haven't used -52 modifier, but from what I have gleaned researching today, it tells the insurance to reduce what they pay us, not that we have reduce our rate.  Is that correct?

Also, I think I would have to send these claims paper?  Our software doesn't have any way to input a patient payment/adjustment on the claim.  Should I attached the hardship documentation or just leave it be until it is asked for?

[PMRNC]

Yes you can use the modifier 52.. BUT do not reduce the fee, they will do that, if you reduce the fee it's just going to further reduce it!

Also, I think I would have to send these claims paper?  Our software doesn't have any way to input a patient payment/adjustment on the claim.  Should I attached the hardship documentation or just leave it be until it is asked for?

Seriously? How do you enter patient payments, or adjustments?  I have an adjustment code I use, the adjustment/payment/discount amount will show in box 29. In an older software I had, I would have to mark the claim "paid" by primary carrier, place the adjustment/discount and then put the claim status back to unbilled so that it would go out. Now I can enter adjustments before and after..thankfully.

[PMRNC]

Oh one more thing. Never give out the patient's financial hardship agreement. It's actually a part of patient/doctor confidentiality.
The carrier does not need it, as you are billing the proper way to show the discount. DO keep it in the patient's file and make sure it's updated at least annually to reflect any income changes or financial status changes.

[platmedrec1]

Seriously? How do you enter patient payments, or adjustments?  I have an adjustment code I use, the adjustment/payment/discount amount will show in box 29. In an older software I had, I would have to mark the claim "paid" by primary carrier, place the adjustment/discount and then put the claim status back to unbilled so that it would go out. Now I can enter adjustments before and after..thankfully.

In short, the software sucks.  It is not user friendly and neither is the support.  Thankfully we are switching software soon, but are waiting until the expansion construction is complete.

Good to know about the hardship info - I wasn't sure.