General Category > General Questions

Different Fee Schedules

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dfranklin:
He does not take medicare either.

Is it the biller's position to explain this to the provider?  What are the problems? What are the ramifications on the providers end if he continues billing this way? Biller's end?

Michele:
You should advise him of the things he is doing that are not right.  Many times they just have no idea that they are doing anything wrong.  Have a suggestion for him for what he should do. 

For workers comp patients you are suppose to bill out at the workers comp fee schedule amounts.

Michele

Pay_My_Claims:
actually for comp, u don't have to bill at the fee schedule, just know that they will only pay whats listed on the fee schedule at the approved amount. each carrier should be billed the same for each code.

Michele:
I don't know if that varies from state to state but I got a call from the NYS Insurance Commissioner for one of my providers because we billed a WC claim out at regular fees.

Michele

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