Billing > Billing

fee schedule

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PMRNC:

--- Quote ---I put his new fee's in writing and had it state, that all clients will be billed the same fee across the board for each CPT code his office bills for
. I will be meeting him on Saturday and going to make him sign and date and having it notarized.
--- End quote ---

Good job, and it's not like you won't know he's not doing it since you will be billing :)    My frustration was not with you but FOR you. Hope you know that :)

Sportsmom:
Yes I did. I just took over two weeks ago for him. What a mess it is. Thank you again for you help I'm so glad you are all here to check with. 

dekenn:

.. technically you cannot legally continue with that line of billing anyway because now you have knowledge of it. I would tell him this and let him get someone else to break the law or prove it.
[/quote]
I thought it was just illegal to bill Medicare more than you bill anyone else. If you're just putting the allowable on the claim, why is that illegal? I can see how it can become complicated changing "fees" according to insurance companies, but that's a bookkeeping issue.

PMRNC:
From Medicare site:

"Some practices charge for procedures based on the Medicare-allowable amount, automatically write off the difference between what they normally charge for the procedure and the Medicare allowable, and bill Medicare the allowable. Then, when Medicare pays its 80 percent of the allowable, the practice can easily determine and record in its billing computer system the 20 percent owed by the patient. Practices do this to avoid billing patients more than their 20 percent of the allowable, which is a violation of Medicare law.[/u]
 
The problem with automatically writing off the difference between what you normally charge and the Medicare allowable and billing the allowable amount is that you are, in effect, reducing your charge to Medicare. Dont confuse charges with payment. Your charges should be the same for everyone, regardless of payer. What you charge for a procedure is based on several factors, such as your costs for supplies, personnel, facilities and services, and a small profit. If your other contracted payers discover you charge Medicare less than you charge them for the same services, they will demand the same discount. Having different charges for the same services could increase your chances of an audit by CMS, which runs Medicare. Because your charges are different for the same services, Medicare will check whether you are charging it more than other payers, which Medicare considers fraud and abuse, and whether you are making false claims to the federal government. When you submit the amount of allowable or the amount of expected reimbursement as the charge to Medicare, you are not giving the federal government a true picture of charges for the services. That can affect the level of reimbursement the government decides to pay for Medicare patients."

dekenn:
That to me, says that it's better that you bill everyone the same, but not that you're legally bound to.  I read the statement, "Practices do this to avoid billing patients more than their 20 percent of the allowable, which is a violation of Medicare law" as meaning.. It is a violation of Medicare law to bill patients more than their 20 percent of the allowable.  The object of the phrase "which is a violation of Medicare law" is "billing patients more than their 20 percent..."

Not that I'm arguing the common sense of it... I just don't think it's "illegal". Yes, it may raise red flags, yes, it may get you audited, yes, it may get you in trouble with other insurances, but not "illegal"
JMO

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