Author Topic: Therapy services billing  (Read 697 times)

mhooyer

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Therapy services billing
« on: February 20, 2014, 01:39:34 PM »
Hello again,

I have signed a pediatric therapy clinic that provides PT, OT, ST to peds.   I am handling there outpatient billing.  We are in the process of getting them credentialed.  We have our first patient coming in tom.  They have BCBS.  Since we do not have a contract yet, how do I find out how much to charge them.  The owner wants to go ahead and send claim out of network.  Dont know if this is a good idea, or we should just wait?  Also any resources out there for this type of billing or if someone is currently doing this type of billing I would love to chat with.  Thanks.

Matt

PMRNC

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Re: Therapy services billing
« Reply #1 on: February 20, 2014, 03:32:47 PM »
Depends on when you sent in the BCBS App., I'm  I will tell you this.. if it gets processed out of network patient will receive any monies. BCBS does not honor assignment of benefits for non par providers. If you have not at least sent the app or you can get a temp credenial process I would have patient pay in full. I have all my non par BCBS clients collect all fees up front.
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shanbull

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Re: Therapy services billing
« Reply #2 on: February 21, 2014, 09:17:05 AM »
We do see some PT patients on a cash basis but A) they're adults B) We're located in the midwest and C) we know most of our cash patients are too poor to afford insurance. So I'm not sure how helpful it would be to give you a ballpark because all three of those factors immensely affect our pricing (and drive it down). But if someone were to come in on a cash basis, we'd probably charge a total of $75 for the evaluation plus one or two modalities (manual therapy, ultrasound, or exercises). We would lower it for the patients we know are destitute (most of them have been with our clinic for years so we do know what their financial situations are).

I would definitely have the providers hold off on ordering any type of supplies or custom DME for patients until the credentialing is all sorted out.