Does any one have experience in finding out what the maximum amount billed per CPT code and how to find these criteria from insurance companies? Are we soppose to go by what the doctor tells us he bills? (Does a doc receive a fee schedule when he/she PARed with the insur. co?) If the doctor wants to know how much he can bill to insurance co he does not participate with, what do you tell him? To bill his regular amount and have the inusrance pay what they allow, or will the claim be denied completly this way? thanx
It's really important that you get the allowed amounts from several companies and make sure that your U&C is higher than that. In California, Blue Cross cuts our bills over 50%, Blue Shield pays better, AETNA pays even better. If your U&C is too low, it can cause the insurance companies to lower the allowed amount the next time their schedule is set.We got our first raise on Blue Cross in 10 years this year (we get an extra $1 per visit, WOO HOO!). Blue Shield, however, reduced our allowed amount.Your doctor's fee schedule should be looked at annually to make sure you're getting all that you can, and to make sure you're billing the right codes!