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write-off

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margemib:
Michele
can a provider charge a patient for a bal. that the ins. did not allow if he is a PAR provider?
margemib

thatcuteblonde:
MY understanding is If they didn't allow it because it's above the contracted rate, then no. If they didn't allow the entire charge for reasons such as medical necessity or maxed benefits, then you can charge the full rate.

Pay_My_Claims:

--- Quote from: thatcuteblonde on April 21, 2009, 04:37:21 PM ---MY understanding is If they didn't allow it because it's above the contracted rate, then no. If they didn't allow the entire charge for reasons such as medical necessity or maxed benefits, then you can charge the full rate.

--- End quote ---

Not always. Just because a benefit has been maxed does not make it the clients responsibility. Check your denial codes carefully. Also someone should be verifying coverage prior to obtaining services for services that have max (physicals, refractions, blood draws etc)

thatcuteblonde:
If benefits have been maxed you always have the right to collect from the patient. Granted you should not continue to treat a patient without notifying them that they have maxed their benes, but under no circumstances does any insurance, contracted or not, have the right to tell you that you cannot collect at least the allowed amount from the patient.

I agree that you should read your RA codes. I've personally encountered numerous issues with UHC since PHCS merged with Multiplanwill and bills are being discounted regardless of our non participating status. Since we were contracted with PHCS, it superceded all other agreements and obligated us to write off excessive amounts, even though we should have been able to collect on them as a non participating provider.

Know your contracts and their regulations. Companies like United Healthcare are finding ways to discount bills by up to 80% through outlets like Multiplan, TRPN and other subsidiaries. If you are billing for a specialty like pain management, you can see a huge loss of revenue due to write offs of this nature. If you think the amount they are allowing is unfair, you might want to look at the pros and cons of remaining contracted and look into your options.

Pay_My_Claims:
You can't collect from a medicaid client who's benefits have been maxed. They have allowances on procedures (eye exams, physicals dme equipment, chiropractic visits etc) once they max, you CAN NOT bill them!

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