Wiki Billing a patient for Non-Billable services

[sjriam@gmail.com]

Hello,

I am working on determining how best to advise a provider on non-billable consultations and whether or not we can charge the patient cash. Because the consultation does not meet criteria for an in office/outpatient consultation (99242-99245) and is patient initiated (not peer to peer), I believe it would not be billable. Can we bill the patient a cash price if we provide a cost disclosure before the services are rendered indicating that we cannot bill insurance and what their cost will be? For reference, we are in network with this patient's insurance.

 

[shanamarie]

Hello,

I am working on determining how best to advise a provider on non-billable consultations and whether or not we can charge the patient cash. Because the consultation does not meet criteria for an in office/outpatient consultation (99242-99245) and is patient initiated (not peer to peer), I believe it would not be billable. Can we bill the patient a cash price if we provide a cost disclosure before the services are rendered indicating that we cannot bill insurance and what their cost will be? For reference, we are in network with this patient's insurance.

I may not be following this completely, but was the service an office visit? If so, why not look at billing a new or established patient visit, if a consult is not supported?

 

[sjriam@gmail.com]

The provider typically provides these consultations as a separate service, she does not always establish care. If she does establish care she then uses the 99202-99205 and 99212-99215 codes. Additionally, the consultation services are rendered in the patient's home as well.

 

[jkyles]

Hi there, a provider can report an office (or in this case home/residence) E/M visit for a patient even though they don't establish care. I would check the contract or talk with a rep. to see if billing the patient in this way is allowed.