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We bill $ 528.00 on a certain procedure code to every insurance company (commercial or Medicare). Based on our individual agreement with those insurances, we write off the difference to get down to our contracted amount (when it is a covered service). However, there are some commercial companies that consider the procedure investigational and/or not a covered benefit, and deem it "non-covered" and patient responsibility.
Can we offer a discounted price to those patients whose insurance does not cover that procedure, as long as the discounted price is the same for un-insured patients?
My physician has concerns about us having "different fee schedules", however the way I see it, we have *one* fee schedule ($ 528.00 billed to all carriers), and we simply offer our own discount when it is non covered, rather than the contracted amount (or making the patient pay the entire amount).
I have tried looking for this on the OIG website, but so far all I have been able to find is reference to un-insured patients.
Any thoughts are appreciated, as well as any links to specific sites (including the OIG).
The CPT® codes that are considered a laboratory test under the Clinical Laboratory Improvement Amendments (CLIA) change each year, as well as throughout the year, making it difficult for healthcare providers and laboratories to keep up. Here are the CPT codes for 2019 that are subject to or excluded from CLIA edits in easy-to-look up […]
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Before your healthcare organization hires on new staff, check the List of Excluded Individuals and Entities (LEIE). It’s also a good idea to verify your current employees, as well. Not checking it could put you at risk for civil monetary penalties (CMPs). Government Protecting Tax Dollars If a provider or healthcare worker or entity is […]
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The Department of Health and Human Services (HHS) Office of Inspector General announced November 15 that Labib Riachi, a New Jersey OB/GYN specializing in urogynecology, agreed to a 20-year exclusion from federal health care programs to resolve allegations that he submitted false claims to Medicare and Medicaid for Pelvic Floor Therapy services that were never provided or were provided improperly. While denying liability as part of a $ 5.25 million settlement […]
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