1. B

    Question Out of Network Provider Different Charges

    99% sure I know the answer but I'd love to confirm A provider cannot charge different rates for the same service based on what the insurer allows, correct? And this applies to both in and out of network providers, yes? As an out of network provider doesn't have a contract with the insurer I...
  2. K

    Question Fee Schedule Question

    Hello, If a payer reimburses for a code at your full charge, and when you reach out to the payer you realize your allowable is higher than your charge, is it okay to send a corrected claim with higher charge on the code to maximize reimbursement for that service? If yes, can you send the...
  3. L

    Billing Medicare as secondary

    We are Urgent Care and have an Ancillary contract with Cigna,UHC, and Aetna requiring us to bill S9083 at a flat rate regardless of what was done. I have a patient that is Medicare secondary. Cigna applied charges to pt deductible now I need to bill Medicare but they do not take the S codes...
  4. D

    Facility ESI Billing-how do you

    how do you bill hospital charges for ESI's using independent CRNA's?
  5. D

    Facility ESI Billing-I need to bill

    How do I need to bill hospital charges for an independent CRNA?
  6. D


    I am reviewing charges for 57160 Fitting and Insertion of Pessary or other intravaginal support device. There is a clinic that is billing the 57160 and a physician is billing it the same day. Since this is done in the physician's office, why would the clinic be billing it? Seems like double...
  7. A

    Billing representative

    Chiropractor billed for his services the same day we billed physical therapy charges. Chiropractor services paid and our charges denied as max benefit met. How can we get paid for our services because we are different specialty. Is there a modifier we could use?
  8. M

    Care plan oversight charges

    I feel so dumb. Does anyone know the location code for the care plan oversight charges? :o