OON Billing Questions

[lbd122]

Hello Everyone,

I work for an OON provider.  Let's say our billed charges are $200.  The insurance pays $80 and says the member responsibility is $20.  Our cash rate is $80.  Can I just do a courtesy adjustment for the patient so they don't have to pay the $20? 

I ask this because if the insurance had paid only $60 I would have balance billed the patient the remaining $20 to get at least our cash rate....since we are OON.  Can I do the opposite of that?  Give a courtesy adjustment so the total amount we receive is $80 and the patient does not have to pay more out-of-pocket?

Thank you in advance!

[PMRNC]

If you give a courtesy discount you must do so BEFORE the claim is processed. If you are going to write off that fee it has to be shown on the claim. The insurance company has the same right as the patient to discount.. essentially this means they will pay less ..why should they pay more if you discount it? Courtesy adjustments/discounts should not be done routinely as that would make it illegal. If a patient is a "hardship" case, there should be a hardship policy signed by the patient and again you have to report this discount to the carrier.