Author Topic: fee schedule  (Read 3122 times)

dekenn

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Re: fee schedule
« Reply #15 on: March 09, 2011, 09:57:25 AM »
How on earth does that mean that you're waiving the coinsurance?????  If the coinsurance is $16.00 using my previous example, and you bill the patient $16.00, how is that waiving the  coinsurance?  If the Medicare allowable is $80.00, again, using my previous example, and you put $80.00 on the claim, how does medicare interpret that as waiving the coinsurance?????? THey will pay $64.00, and show patient balance of $16.00, which is then billed to either secondary or patient, it is in no way shape or form being shown as "waived"!!!!

I stand by my original interpretation.

PMRNC

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Re: fee schedule
« Reply #16 on: March 09, 2011, 09:58:12 AM »
OK... It took me a while..BUT I get what you are reading.. I get it now:


Quote
"Some practices charge for procedures based on the Medicare-allowable amount, automatically write off the difference between what they normally charge for the procedure and the Medicare allowable, and bill Medicare the allowable. Then, when Medicare pays its 80 percent of the allowable, the practice can easily determine and record in its billing computer system the 20 percent owed by the patient. Practices do this to avoid billing patients more than their 20 percent of the allowable, which is a violation of Medicare law.[/u]

What you are interpreting.. I get it now..  Practices that bill that way to avoid CHARGING MORE THAN THE COINSURANCE, which is illegal. In other words if they billed the patient $84 instead of $64 (based on your example) that would be illegal. So they do so to avoid that ?  Correct.    I tried to ask my attorney yesterday (he's a Medicare reg wiz, but somewhat a typical attorney with a typical attitude)  I asked:    Is it illegal for a provider to bill Medicare the allowable RATHER than the physician's fee?  His response:  "Of course it is, why would you ask me that".  ??? ???  He scares me a little.. but I will ask him to clarify it, he knows I will anyway.. LOL

I'm sorry it took me few go around to see what you were reading and I agree it can be read that way.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
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PMRNC

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Re: fee schedule
« Reply #17 on: March 09, 2011, 09:59:21 AM »
We were replying at same time. I went back and read it a few more times :)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

MJ

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Re: fee schedule
« Reply #18 on: March 24, 2011, 12:58:02 PM »
This information brings up another question.  The practice I work for has a policy for uninsured patients.  They have them sign off attesting to the fact that they have no insurance at all.  They have established a discounted fee for these patients of $75 for an office visit.  This does not include procedures, labs, immunizations etc.  It is used for 99213, 99214 type of office visit for a sore throat, Med management, etc.  My question ... is it legal to establish a discounted fee if they bill a different fee to insurance companies?  Can the same be done for preventative visits and procedures?

rdmoore2003

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Re: fee schedule
« Reply #19 on: March 24, 2011, 02:28:13 PM »
if you have all the documentation to back up that the patient says no insurance you are covered.   

For example, a couple of years ago, we started a "hardship" program in our office.  to meet the criteria for this program, patient cannot have insurance or if they do have insurance but no mental health benefits they may qualify.   We have an income fee schedule for this program.   We go soley based on household income before taxes are taken out.   Depending on that income and where they fall on the fee schedule, depends on what they pay.   They must sign off on our form that states what they will pay for intake, 45-50 minute therapy, medication visit, psych. testing, etc.   On the form, it also specifically states that we do not file their insurance (if they have it but no mental health benefits)  It covers us as the provider and also down the road if the patient comes back and says I do have insurance and I will file myself, they need cpt codes and we give them a printout for the insurance company of what our agreement was and invoice showing that what we charged, what they paid, and of course the agreement.   Patients get upset at times that they cant get more money from insurance.   Mental health patients are always trying to pull something......
Regina