Author Topic: Who can pay the administration fee for insurance billing  (Read 1966 times)

sanint

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Who can pay the administration fee for insurance billing
« on: July 09, 2013, 12:36:31 PM »
We are a laboratory that bills insurance for patients from referring practitioners. We charge an administration fee to bill the insurance. A practitioner wants to pay the fee for the patient and then charge the patient what he wants to for the administration fee. Can we allow the practitioner to pay the fee and is he allowed to charge the patient a higher amount for an insurance billing administration fee?

RichardP

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Re: Who can pay the administration fee for insurance billing
« Reply #1 on: July 09, 2013, 03:17:17 PM »
You need to check with a healthcare lawyer on this one.  It sounds to me like what you are doing is illegal.

The law requires that the entity doing the lab work be the billing agent, billed under their own NPI number.  If the doctor performed the lab work in his own physician office lab (POL), you are not legally allowed to bill for that work.  The doctor must bill for it using his own NPI number.  If you perform the lab work in your own lab, you are billing on your own behalf, not on behalf of the referring provider.  You must bill for that work using your own NPI number.  The doctor may not bill for your work.

It is my understanding that neither a doctor nor a lab may bill the patient a fee for billing their insurance.  It is my understanding that doing this will violate the contract either party has with the invidivudal insurance carriers.

Google, or search this site, on pass-through billing.  It is illegal, except in very narrowly-defined circumstances.  This is not one of them.

Can you get away with doing this?  Maybe.  If you get caught, will you be prosecuted?  Almost certainly.

PMRNC

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Re: Who can pay the administration fee for insurance billing
« Reply #2 on: July 09, 2013, 03:31:09 PM »
I agree with Richard.. in addition I always ask my provider to think about : "What will your patient's think" Usually that does the trick.
Linda Walker
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sanint

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Re: Who can pay the administration fee for insurance billing
« Reply #3 on: July 17, 2013, 06:21:25 AM »
Thank you both for your replies. We are not under contract with any insurance carrier. Would us charging a fee still be illegal? We have already told the practitioner that we couldn't allow for that but We are very new at this and I want to know if we are allowed to charge the fee or not.

PMRNC

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Re: Who can pay the administration fee for insurance billing
« Reply #4 on: July 17, 2013, 06:45:10 AM »
Whether you are contracted or not isn't the deciding factor. In most states there are limits on for example whether you can charge interest or late fees, records copying, etc. I know you cannot charge this fee for Medicare/Medicaid patient period. You def want to check state laws on this. Something else to consider; this could become an administrative headache. Fees like this added to patient's bills are usually unenforceable under most consumer laws, can't be credit reported, and you will end up with a lot of write-off's and adjustments. The fee will NOT be paid by the carrier, same thing for no-show/late cancel fees. (services not rendered) It becomes an out of pocket to the patient making it harder to collect. Just my 2 cents. I would have the provider actually study the ramifications of this because it might actually cost more in the long run to implement.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

sanint

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Re: Who can pay the administration fee for insurance billing
« Reply #5 on: July 17, 2013, 07:41:52 AM »
Thanks! By the way, we do not charge Medicare patients anything as we are contracted with Medicare. This fee is stricktly for private insurance billing. We also do not balance bill the patient so we get onlty the fee and whatever the insurance might pay.

PMRNC

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Re: Who can pay the administration fee for insurance billing
« Reply #6 on: July 17, 2013, 08:07:44 AM »
I did a little checking and from what I understand a fee can be charged to the "patient", just not the carrier. But in looking this up I ran across more articles on why it was a bad idea and actually could cost the practice more. Remember that if the provider has an in office billing person/staff they are already paid to do this. IF the provider insists he should notify all patients in advance AND make sure it is in their office financial policy. Since some states Medicaid can be a total pain in the rear end many patients may  have a problem paying for this service when Medicaid won't allow patients to be charged for filing fees.  And also what if the patient brings in their own forms, your policy wants to be flexible on this so not to alienate the patients that do want to avoid this fee. Many group plans have their own forms and all provider has to do is sign it if the patient brings it in. And for the forms you are filing, again, wouldn't the salary/pay of the biller justify the added work?  Again, just my 2 cents. Oh and if they use an outsourced billing company.. wow I would have a big problem with paying an added fee. I still would have a problem paying additional monies when they have staff that are paid to do this.   And yes.. I am aware that some carriers are a pain in rear with extra paperwork as I do mental health billing where forms can take a little time, but my pay from my clients covers those services as it's my job.   
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

sanint

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Re: Who can pay the administration fee for insurance billing
« Reply #7 on: July 17, 2013, 08:28:20 AM »
Thank you so much! I am going to pass all of this information on to the owners and see what we can do!

Merry

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Re: Who can pay the administration fee for insurance billing
« Reply #8 on: July 18, 2013, 05:24:33 PM »
Why is there no patient billing? Are you saying that the provider only accepts insurance only? I understand about not billing Medicare patients as the allowed amount is paid at 100% for lab work but is that true for all commercial insurance companies? I doubt it but I could be incorrect.
« Last Edit: July 20, 2013, 01:21:00 PM by merry »