Do I have to file for non paid services?

[dfranklin]

Are we required to file/report services that are not paid for by medicare or other carriers?  Meaning if we know we are not going to get paid by the carrier and have the patient pay cash or the provider just is including it in the service can we leave it off of the claim?  This is a common occurence for chiro's as they are limited on what insurances pay for them.

Thanks!

[Pay_My_Claims]

We file all non-covered charges.

[Michele]

I also advise my providers (especially DC's) to bill for all services rendered.

Michele

[dfranklin]

What is the reasoning to do so?  I want to have a good reason to explain to my provider.

Thanks for your help!!!!

[Michele]

If the service was provided, it should be reported.  Patients are always concerned if they are being charged differently than their insurance is being billed, and they absolutely should be.  Also, I tell providers, the insurance carriers collect data from all claims submitted and do studies.  If the carrier allows $30 for a chiro visit, and the chiros all bill $30, the carriers data will show they are paying the full amount of what chiros bill and they are right on track.  It should show, they allow $30, but the average chiro bills for a manipulation  for $45, ultrasound for $20 and electric stim for $20. 

I also think there is a legal issue in not reporting all services performed.

Michele

[dfranklin]

Thanks Michelle! This really helps and is great information!

Have a great day!