Medical Billing Forum

General Category => General Questions => Topic started by: tlovita1@aol.com on February 03, 2011, 10:23:12 AM

Title: Copays
Post by: tlovita1@aol.com on February 03, 2011, 10:23:12 AM
Hi :),
My dr sees the patient for patch testing, and charges a copay, then 3 days later the patient comes back for the results of the patch, should we charge a copay for the f/up visit of that patch?
So the patient is paying, we'll say 50.00 on 1-3-11 , then 3 days later she is paying another 50.00 copay.  Should we not collect the copay for that f/up visit?
Title: Re: Copays
Post by: rdmoore2003 on February 03, 2011, 02:54:17 PM
If I understand the question, when pt comes back 3 days later, that would be a f/u (follow up) then no you would not.....
Title: Re: Copays
Post by: Pay_My_Claims on February 03, 2011, 03:01:44 PM
is it a visit or a "no charge" . Its like a TB test, there is a charge to give and a charge to receive. Those are billed as Nurse Visits, so no copay for those. Some physicians do a "no charge" visit. for certain f/u
Title: Re: Copays
Post by: tlovita1@aol.com on February 07, 2011, 07:33:10 AM
The f/up is considered a visit, we charge for it, but the dr wanted to waive the copay for the f/up visit, so should we waive the copay?
Title: Re: Copays
Post by: PMRNC on February 07, 2011, 08:14:44 AM
If you are billing the insurance, than if you waive the copay you need to let the insurance carrier know as well. you cannot discount the patient w/out discounting the carrier. I don't even know that you bill the carrier for a followup for that?? If a followup was required wouldn't it be included in the original charge/CPT?
Title: Re: Copays
Post by: DMK on February 07, 2011, 11:52:59 AM
Just chiming in....if the Doctor is charging for an office visit it's my understanding you HAVE to charge the Co-pay.  If the visit goes to the patient's deductible, you would have to collect the deductible.  A CHARGED for visit is a visit you have to charge for!  I would hope that the visit is charged for appropriately too.  I can't stand seeing a doctor charge for a detailed visit (99214 or 215) when he spent 2 minutes.  The detailed visit would have been the 1st visit (99215), and the follow up should be a minimal (99212).  The co-pay is the same for both, but the reimbursement is different, if the visit goes to the patient's deductible the second visit would be less than the first visit.
Title: Re: Copays
Post by: rdmoore2003 on February 07, 2011, 03:07:10 PM
i think it may also depend on the dx code.   for instance, my son has blue cross and went to dr for appt was charged like a 99213 we paid his copay.  that was done correct.   then 2 weeks later we went for a f/u.    claim was sent to insurance as 99212 but dx code was a v code used as a f/u visit.  per my eob, dr was reimbursed for 99212 but due to dx I was not responsible for copay on f/u visit.     this has happened many times with my family and in different dr offices that i have seen.   Are the insurance companies doing this wrong????
Title: Re: Copays
Post by: DMK on February 07, 2011, 03:59:47 PM
That's excellent, and good to know for the future!