Wiki Administrative costs

[pammalou]

This is a general question, not necessarily coding related but billing related. Our administrators are wanting to charge a flat fee to our patients for various administrative costs. the patients sign a notice that they may/will be charged for these services ie; preauthorizations, nurses phone consultations, drug formularies... Does anyone know if this can be billed to Medicare and/or Medicaid patients? If so/not, do you know where I can find the documentation to back it up? I appreciate your help.

 

[FTessaBartels]

Already covered

Administrative costs - like all overhead (electricity, office rent, staff salaries) - are already reimbursed as part of the RVUs of any service provided.

Consider how many patients you might lose if you start imposing these types of additional charges.

F Tessa Bartels, CPC, CEMC

 

[pammalou]

But would nurses time for preauthorizations, formularies, etc... be considered in overhead or could we have the patients sign a notice that they will be charged for these services and bill them? This would be for all patients, I am just not sure if we could charge Medicaid or Medicare patients and if not, where can I find the documentation to show our administration...That is ultimately what I need. Thank you.

 

[lorrpb]

Nurse and other staff time is included in the RVUs. I'm not sure offhand which component it is, but my guess would be Practice Expense.

Here is some info from AMA about the RVUs:

http://www.ama-assn.org/ama/pub/phy...the-resource-based-relative-value-scale.shtml

 

[LLovett]

I. CHARGING BENEFICIARIES FOR EXTRA FEES

WPS Medicare has received notification from the Centers for Medicare&Medicaid Services (CMS) Regional Office that they have received inquiries about providers billing beneficiaries extra fees such as a finance charge, interest, or other types of charges.

The CMS Central Office verified that a charge by a physician or supplier for interest on unpaid balances is a violation of Medicare's assignment or limiting charge rules and is also a violation of the physician's or supplier's participation agreement. Medicare views the addition of interest or penalties to a charge for a Medicare covered service to be an increase to the charge for the Medicare covered service and therefore may not be collected by the physician or supplier. This applies to any type of extra fee.

In accepting assignment, providers agree to follow the 42 Code of Federal Regulations (CFR) 424.55. The 42 CFR 424.55 (b)(2)(ii), in part, states the following:

"To collect only the difference between the Medicare approved amount and the Medicare Part B payment (for example, the amount of any reduction in incurred expenses under Sec. 410.155(c), any applicable deductible amount, and any applicable coinsurance amount) for services for which Medicare pays less than 100 percent of the approved amount."

The regulation implementing Medicare's assignment provisions is located at 42 CFR 424.55, at the following Website:
http://www.gpoaccess.gov/cfr/retrieve.html

Hopefully this will be helpful,

Laura, CPC, CPMA, CEMC

 

[mitchellde]

But would nurses time for preauthorizations, formularies, etc... be considered in overhead or could we have the patients sign a notice that they will be charged for these services and bill them? This would be for all patients, I am just not sure if we could charge Medicaid or Medicare patients and if not, where can I find the documentation to show our administration...That is ultimately what I need. Thank you.

If you cannot charge it to Medicare then you cannot charge it to anyone else. Nurse time for this type of activity is a cost of doing business it is included in the RVUs for every thing you bill for and you may not charge for it again.

 

[pammalou]

thank you

That is what I needed, thank you very much.