Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: susan on July 21, 2008, 01:00:09 PM

Title: MVA Auot ins and medical ins
Post by: susan on July 21, 2008, 01:00:09 PM
Its for a chiro office located in NC.  The dr wants to bill the auto and whatever they do not cover he wants to bal bill the medical ins company,it that legal??
Title: Re: MVA Auot ins and medical ins
Post by: Michele on July 21, 2008, 08:19:31 PM
Hi,
    Usually NF allows a chiropractor to just bill an ov for the fee schedule amount.  For example, in NY we bill 99213 for $27.11.  They pay the full $27.11 so there is nothing left over.

   Does the Dr want to bill for modalities and/or the regular fee for the manipulation?  Do they plan on billing with the NF eob attached?

   It is not legal to bill both a NF and a commercial insurance for the same services.  And if you accept the NF case then you are saying that you accept the fee schedule.  You can't bill the patient more than NF allows.  Most insurance carriers will deny any claims that they feel are related to a MVA.  If they are unaware of the MVA, and they find out later they will request the money back, which is a nightmare. 

   The only time you can bill a NF claim & a commercial claim at the same time is if the NF claim is for one body part, and you are still treating other body parts that were not injured in the MVA.  For example, if a patient has whiplash from an MVA and they also have chronic low back pain, but the low back was not injured in the MVA, you can bill for the NF visit and you can also bill the commercial carrier for the low back but you must document it well in the patient's chart.

I hope that helps you out!


Michele