Wiki Anesthesia 50/50 split

[joyjankowski]

Hi,

Fairly new to Anesthesia coding, can some one help me understand how insurance companies process a 50/50 split when an MD and a CRNA both submit separate bills for services? if the industry standard allowable amount is 50% do I have to write off the remaining 50% or can I bill the patient that amount? Essentially the patient could get billed the remaining 50% from both providers and essentially end up owing the entire 100%. Is this correct or can you direct me to where I can find more information?

Thank you!

 

[CodingKing]

You bill the full amount under each provider then payer pays 50% to each totaling 100% of the allowed amount. You world write off the rest. Otherwise you would be double dipping. The problem I always ran into as a payer was the billing provider doing the reduction and then we will reduce again since there is no way to know if what you are billing is the real amount or not. Its falls under the premise that the physician and the CRNA share responsibility for providing the services so each gets a portion of the payment. It would be much easier if there wasn't a CRNA bill and let the provider figure out how they want to split it. I know some carriers will accept a single claim with only the MD name and 2 lines, one for the AA and one for the Q- modifier