Medical Billing Forum

General Category => General Questions => Topic started by: mforgione on August 01, 2012, 09:27:35 PM

Title: Insurance Fee Schedule/Self Pay Fee schedule
Post by: mforgione on August 01, 2012, 09:27:35 PM
Question: My clients (client 1) bill to insurance a set fee schedule. They charge their patients who do not have insurance or who have insurance for which they do not par with the same rate...however, since it is the same price (self pay and insurance rate)it seems legit to me...I have another client who bills out services to the insurance company at one rate which is coded appropriately and for self pay patients she states ie, 99205 is 275-she calls this a new patient visit and a 99214 is 150 and she calls this a follow up.
If she makes the financial hardship income $250,000 can she (second client I mentioned) do a sliding scale for patients? Does she have to have this policy written up in a handbook? The second client stated that she felt she can charge cash patients whatever she wanted. I read some other posts in the forum and am slightly confused now.
Please advise
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: DMK on August 02, 2012, 11:29:17 AM
Financial policies should absolutely be written up and strictly adhered to.  There should be a set rate for patient pay and a policy for hardship.  It should NOT be different rates for different people.

Patient's do get frustrated when they change insurance and their portion changes.  Blue Cross pays much less to contracted providers than Blue Shield does.  So if the patient has a high deductible, they end up paying a lot more out of pocket and they want to know why.  It's a hard discussion.  It's easier, though, when they present their card and you tell them right up front what they can expect to pay out of pocket.  Then there's no surprises.
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: sandyb52 on August 03, 2012, 03:10:21 AM
Do I understand correctly that it is ok to charge self-pay patients a certain amount that is lower/different than that charged an insurance?
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: DMK on August 03, 2012, 10:16:57 AM
You can have a cash discount.  You should still enter the SAME charges as your insurance fee schedule (which should be them same rate you charge ALL insurance other than worker's comp), then have a line item showing the cash discount.
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: mforgione on August 03, 2012, 12:34:26 PM
Thank you! :)
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: sandyb52 on August 03, 2012, 01:40:37 PM
Thank you soooo much!
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: Michele on October 22, 2012, 11:27:40 AM
Huh?
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: PMRNC on October 22, 2012, 03:46:29 PM
Quote
Huh?

Quote
If she creates the economical problems earnings $250,000 can she (second customer I mentioned) do a moving range for patients? Does she have to have this plan published up in a handbook? The second customer described that she sensed she can cost money sufferers whatever she desired. I study some other content in the community and am a little bit puzzled now.

Double HUH???
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: rdmoore2003 on October 22, 2012, 03:48:49 PM
I know its Monday, but I have read all the posts for this, and I guess my reply is:

TRIPLE HUH????
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: DMK on October 22, 2012, 06:26:41 PM
Seems like something is being lost in the translation!  So I see your Huh? and raise you!
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: Michele on October 23, 2012, 07:53:18 AM
Glad to see I'm not losing my mind.  I almost deleted it but thought "maybe I'm missing something??"
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: supertaz93 on October 24, 2012, 07:00:11 AM
You just posted the same thing that none of us understood above.  So once again, HUH?
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: DMK on October 24, 2012, 10:22:57 AM
Since John Smith can't spell John correctly, I think we're being scammed. "Varicose veins phoenix"  ???
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: rdmoore2003 on October 24, 2012, 02:09:58 PM
He is wasting our time.  None of this is understandable.   Michelle, I vote to remove his posts.
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: PMRNC on October 24, 2012, 06:26:43 PM
All in favor say "HUH"  :)
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: rdmoore2003 on October 25, 2012, 03:05:18 PM
All in favor say "HUH"  :)

"HUH"
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: mzmelodee2010 on October 26, 2012, 07:22:26 PM
Are you asking if she has to publish a sliding-fee schedule in a handbook? Also, is she saying she can charge her patients that have a financial hardship, anything she wants?
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: QueenAlicia on October 29, 2012, 01:17:20 PM
HUH, wow lol.
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: Michele on October 30, 2012, 07:21:48 AM
I did a little research on him and decided to delete all his posts.  I do believe it was spam.  It was on topic, but rambling and didn't make sense.  :)
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: Cmporter82 on November 02, 2012, 12:56:17 PM
Getting pack to the OP for a second...How can your client say that she can bill every new patient a 99205 and every follow up a 99214? That alone seems strange to me :P  With new patients you have to have 3/3 elements to bill, so in my experience, they are usually actually coded lesser than they would be for an established patient. 
Title: Re: Insurance Fee Schedule/Self Pay Fee schedule
Post by: QueenAlicia on November 02, 2012, 02:04:16 PM
Does your client have any fee schedules from the insurance carriers that they bill from?