Billing > Billing

Who can pay the administration fee for insurance billing

(1/2) > >>

sanint:
We are a laboratory that bills insurance for patients from referring practitioners. We charge an administration fee to bill the insurance. A practitioner wants to pay the fee for the patient and then charge the patient what he wants to for the administration fee. Can we allow the practitioner to pay the fee and is he allowed to charge the patient a higher amount for an insurance billing administration fee?

RichardP:
You need to check with a healthcare lawyer on this one.  It sounds to me like what you are doing is illegal.

The law requires that the entity doing the lab work be the billing agent, billed under their own NPI number.  If the doctor performed the lab work in his own physician office lab (POL), you are not legally allowed to bill for that work.  The doctor must bill for it using his own NPI number.  If you perform the lab work in your own lab, you are billing on your own behalf, not on behalf of the referring provider.  You must bill for that work using your own NPI number.  The doctor may not bill for your work.

It is my understanding that neither a doctor nor a lab may bill the patient a fee for billing their insurance.  It is my understanding that doing this will violate the contract either party has with the invidivudal insurance carriers.

Google, or search this site, on pass-through billing.  It is illegal, except in very narrowly-defined circumstances.  This is not one of them.

Can you get away with doing this?  Maybe.  If you get caught, will you be prosecuted?  Almost certainly.

PMRNC:
I agree with Richard.. in addition I always ask my provider to think about : "What will your patient's think" Usually that does the trick.

sanint:
Thank you both for your replies. We are not under contract with any insurance carrier. Would us charging a fee still be illegal? We have already told the practitioner that we couldn't allow for that but We are very new at this and I want to know if we are allowed to charge the fee or not.

PMRNC:
Whether you are contracted or not isn't the deciding factor. In most states there are limits on for example whether you can charge interest or late fees, records copying, etc. I know you cannot charge this fee for Medicare/Medicaid patient period. You def want to check state laws on this. Something else to consider; this could become an administrative headache. Fees like this added to patient's bills are usually unenforceable under most consumer laws, can't be credit reported, and you will end up with a lot of write-off's and adjustments. The fee will NOT be paid by the carrier, same thing for no-show/late cancel fees. (services not rendered) It becomes an out of pocket to the patient making it harder to collect. Just my 2 cents. I would have the provider actually study the ramifications of this because it might actually cost more in the long run to implement.

Navigation

[0] Message Index

[#] Next page