OK, then question. Client pays for visit, as a cash discount. Provider is par with the insurance. Provider gives patient cash discount. He said 97001 150.00 (his fee schedule). Cash discount 80.00 and she pays 70.00. What if the allowed amount on that charge is 60.00?? and they are a network provider??
There's nothing wrong with providers that take cash and have the patients file their own insurance AS LONG as they don't participate with that plan and as long as they are giving valid receipts/billings so that when this situation arises the patient has a bill for services rendered and paid to submit to their insurance company and they MATCH. You can't bill the patient one fee and the carrier another.
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