I am wondering a few things:Is there a way to bill at the LP's rate legally
Is there a way to avoid PGIP, we are not a part of any physician group, and have not been previously charged this.
If the BCBS max allowable for our practice is $160 for LP should we bill $160 or slightly under? Why is this information so hard to find?
I'm not sure what you mean by this. Don't you bill all services at the same fee and then let the insurance carrier process at the appropriate rate?
Are you in Michigan? Are you referring to the BCBS PGIP? If so, you would have to check with BCBS to find out if you can avoid it.
Most medical offices set a fee schedule for their services. All services should be billed at that fee schedule and then adjusted according to the EOB/ERA. It is common for offices to set a fee schedule anywhere from 125-160% of Medicare allowed amounts for their area, even if they do not enroll with Medicare. It's a good gauge to use when setting fees. For example, if Medicare allows $67.56 for a 90834 the a common fee might be $95. I hope this is helpful!
Quote from: Michele on August 14, 2018, 04:14:29 PMI'm not sure what you mean by this. Don't you bill all services at the same fee and then let the insurance carrier process at the appropriate rate?Well, previously (and probably incorrectly like I said), all of our LMSW/LPC/LLP billing was done directly under the LP's NPI number (only for BCBS). So we received the rate for an LP. So we did bill at the same fee, but we didn't include modifiers to indicate that there was a lower licence level because our (mis)understanding was that we were able to bill under the supervisors lisence.
QuoteAre you in Michigan? Are you referring to the BCBS PGIP? If so, you would have to check with BCBS to find out if you can avoid it.Yes we are in Michigan, and since we do not participate in any physician organizations, so is there a way to not be forced to pay this fee?
QuoteMost medical offices set a fee schedule for their services. All services should be billed at that fee schedule and then adjusted according to the EOB/ERA. It is common for offices to set a fee schedule anywhere from 125-160% of Medicare allowed amounts for their area, even if they do not enroll with Medicare. It's a good gauge to use when setting fees. For example, if Medicare allows $67.56 for a 90834 the a common fee might be $95. I hope this is helpful!So for us we bill at different rates depending on the insurance (again not sure if that is wrong or not). Aetna at 125, BCBSM at 145, Medicare at 105 etc. Each company has a slightly different cost. I hope that explains it more clearly, and yes you were helpful.