B12 J3420 PPO/Medicare

taysin93

Contributor
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Los Angeles, CA
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Hello Everyone, if patient comes in the office for B12 shot, and pay for it. can we bill as
96372 $40
J3420 $0.01
is it Double Dipping? Thank you :)
 

csperoni

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Selden
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I don't understand exactly what you are asking.
Are you saying the patient paid in full for the services and now you are billing the same services to insurance?
If you know it's a non-covered service, that's not double dipping since 1) The insurance will deny and 2) You should be indicating on the claim submission how much the patient paid. I would also recommend an ABN (or similar for commercial insurance) even if it's statutorily excluded.
If it is a covered service, why did the patient pay? Did they not want it billed to insurance? Are you out of network?
It would be wrong to have both the insurance and patient pay for the same service.
 

SharonCollachi

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Clovis, CA
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If the patient brought in their own B12 injectate, then you are billing correctly and I'm not sure where you think you're double-dipping. If that's not what you're saying, then you probably should clarify for us.
 

taysin93

Contributor
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Location
Los Angeles, CA
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Thank you for the response. so, my practice been collecting $9 for one B12 shot for all insurances, and not reporting to the insurances. i suggest we should report as
96372 $40
J3420 $0.01
I don't think it's double dipping but employer did not think so. I aware PPO and Medicare pay for B12 by on certain diagnosis, and make some money on 96372 as well.
scenario: a Medicare patient with I10 comes in for B12 shot. patient paid $9 , and we bill as
96372 $40
J3420 $0.01
Medicare paid $18 for 96372. is it double dipping? please advise, thank you so much.
 

SharonCollachi

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Clovis, CA
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Stop having the Medicare patients pay in advance, and you may need to stop having the other insurance patients pay in advance, as it may be contrary to your contract.

If Medicare paid $18 for the 96372, what was the patient portion, if any? That's all you can collect from the patient, and you should be making some refunds. Who supplied the B12? If it was your office, you need to bill regular price for that too.
 
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