Billing > Billing

Question about Patients Sending Claim to Insurance

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Pay_My_Claims:
I totally understand and agree with the way the bill should be. Could be my overly peculiar self, but I just don't comprehend the "create the bill" question. Guess it would depend on how the offices are set up. Clients that filed insurance for reimbursements (we were non-par) would only need the superbill to file with the claim (proof of payment).They could download the insurance claim forms online The way you bill will always be the same. If you charge XXX for something, there is no separate fee for cash clients, only a discount. You should never "change" the charge, only do the adjustment. When we print out a statement for a client for taxes or claim filing, it has our charge, any payments or adjustments and balances due. 99.9% of every client I had always asked us to file for them because they don't know how. We have had several try to file and run into issues. (DME provider). We agree, I'm just nit-picking so pardon me :-)

Michele:
The horse is dead already! 

Just kidding.  ;D

Michele

lbd122:
Hi Everyone,

oh wow...didn't know my question would get such heated responses!   ;D  Yes....we are an OON provider.  The patient paid cash b/c they did not think their insurance would cover the bill but they now want to submit the claim to see if they might be reimbursed for any of the fees. 

The rates are different b/c we have our regular "billed charges" (that are never reimbursed fully by insurance b/c of the allowable amts) and we have separate cash rates for those without insurance.  Usually our cash rates are higher than what insurance reimburses.  I asked the question b/c if we had submitted the claim to insurance we would have used our billed charges however since this patient paid the cash rates i was wondering which i needed to give her. 

So....what y'all seem to be saying is that there shouldn't be separate cash rates....just a discount?  Hmm...interesting b/c several other practices (including some big ones) had separate codes/rates for their cash patients.  But y'all would be the experts.  :D 

anyhow...thank you for all of your responses.  sorry it took me so long to reply....didn't know there were responses already. 

Pay_My_Claims:
thanks for clearing that up regarding your provider status. My reason for inquiring was we are non-par providers (DME), and we offer discounts as well. If we charge the client more than the "allowed" amount, we can still balance bill so we would never owe the client any money. If you are par, you could potentially owe if you accepted more than your contracted rate. I dealt more with the abstract than your actual question of how to bill.

I can be anal that way  ;D

PMRNC:

--- Quote ---oh wow...didn't know my question would get such heated responses!   Grin  Yes....we are an OON provider.  The patient paid cash b/c they did not think their insurance would cover the bill but they now want to submit the claim to see if they might be reimbursed for any of the fees.

The rates are different b/c we have our regular "billed charges" (that are never reimbursed fully by insurance b/c of the allowable amts) and we have separate cash rates for those without insurance.  Usually our cash rates are higher than what insurance reimburses.  I asked the question b/c if we had submitted the claim to insurance we would have used our billed charges however since this patient paid the cash rates i was wondering which i needed to give her.

So....what y'all seem to be saying is that there shouldn't be separate cash rates....just a discount?  Hmm...interesting b/c several other practices (including some big ones) had separate codes/rates for their cash patients.  But y'all would be the experts.  Cheesy
--- End quote ---



It's not illegal to have different fee schedules but it is a VERY big disadvantage to do this. There are several reasons your provider wants to have ONE Fee schedule. The first reason is for ease of data retrieval. Let's say you want to look at your provider status with Aetna PPO, your provider needs to see the write-off/Adjustments for Aetna so that he can see how much money is being lost.. you can't do that if you are billing out Aetna PPO fee schedules. The other reason is it hurts the National Databases used to calculate U&C and fee schedules. Data to create these fee schedules and U&C is gathered by looking at charges nation wide and then sorting geographically. If your doctor is charging everyone by the fee schedule of their patients the data is going to be calculated in with all the others and it won't be accurate. It's a dis-service to all providers in your zip code area!

ONE fee schedule across the board is really the right way to do things. Your adjustments should be categorized accordingly.

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