Bill for Physical Exam?

[Kinlaw30]

Do anyone know at what point could you bill patient for physical exam or well check? Example patient have not met their deductible and they had a visit for physical exam and was also treated for knee pain everything was filed on same claim. Provider want to know since it was not filed separately to insurance could she bill patient? Insurance applied allowed amount towards patient deductible.

Also, want to know if it’s fraudulent to not collect copay or deductible from patient on day of the visit?

Thanks-

[PMRNC]

Do you mean charge for the physical after you've billed it with the diagnos pertaining to the knee problem, and that was applied to deductible? 

If that is the case, I'm thinking NO unless the documentation supports it but then you would need to file a corrected claim, but I'm still thinking it's going to go towards deductible. If it's a group health plan you could "try" an appeal but you should attach the providers notes for that visit to see if it qualifies but you'll want a copy of the patient's plan SPD as they may be grandfathered and not contain the physicial exam benefit with no OOP.

As for waiving the oop, that definetely would not be adviseable unless the patient falls into your financial hardship qualifications as per your office financial policy. If it doesn't you could waive it but it would be moot because you'll legally need to file a corrected claim showing the reduction in fee to the carrier.

[Michele]

Also, want to know if it’s fraudulent to not collect copay or deductible from patient on day of the visit?

Thanks-

I think they are asking if it must be collected on the day of the visit.  It doesn't have to be collected on the day of the visit.  In fact, the deductible might not be known on the day of the visit (the actual allowed amount for the services).  Copays should be collected at the time of the visit since it's easier to collect that way, but there are always patients who "forgot their checkbook" or have a valid reason why they can't pay.  It is against most contracts to not collect them, but it doesn't specify that they must be collected at the visit.