Advanced Search

Ophthalmology and Optometry Coding Alert

Reader Question:

Who Do You Bill When You're a Non-Par Provider?

Published on Fri Oct 09, 2009

Question: I have found it impossible to find out the allowable charge when your provider does not participate in a plan. In these cases, can we collect our entire fee from the patient at each visit? Or do we need to wait until we get the explanation of benefits (EOB) and bill the patient? Michigan Subscriber Answer: Your fee is your fee. The insurance company's allowance should not factor into your charge. You should collect your full fee from the patient and submit the claim indicating that you do not accept assignment. Send the insurance payment to the patient, reimbursing her the allowable. Bill the patient: You have no contract with the payer and you are working just with the patient, therefore you can charge your full fee. Remember the patient and her employer contracted with the payer, not you. Good public relations: If the patient has a problem with [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Ophthalmology and Optometry Coding Alert

View All