Physicians Practice: How to Code, Negotiate After-Hours Reimbursement

There are codes in the CPT® code book to report services a physician provides during “nontraditional” hours. If you prove that it’s in the payer’s best interest, third-party insurers may allow additional reimbursement for after-hours services. AAPC’s Managing Editor G. John Verhovshek, MA, CPC, recently penned an article for Physicians Practice, in which he described a few methods to negotiate reimbursement for after-hours services.
“You might succeed with private payers in negotiating payment for after-hours codes as part of a contractual agreement, especially if you use savings potential as leverage,” he says. “Have your negotiator make it clear to the insurer’s representative that you’ll willingly send patients to the emergency department (ED) instead of offering in-office after-hours services, but that ED services can cost as much as 10 times more than comparable physician services.”
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