Are there regulations stating that you are or are not required to bill all payers the same. For example, if we know a payer will never pay a venipuncture do we have to report it if we bill it to other carriers? Should we enter and adjust (increasing write offs?) or not enter in our system? What do other groups do? Documentation would be most helpful. (physician offices)
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Wiki Billing All Payers the Same
- Thread starter Lsacco
- Start date
If you have one payer that pays venipuncture because it is in your contract then obviously you would bill it, because you want to get paid for it.
However, if you have a different contract with a different payer that does not pay venipucture according to contract- you do not have to bill it. It is not in your contract, and billing it just increases your A/R until you adjust it off.
There is no written policy that states if you bill one ins that way then you bill them all that way that I am aware of. Especially when dealing with commercial payers. Know what is covered and payable in your specific contract and stick to that.
For example, some payers contracts state to bill bilateral procedures with a 50 modifier, where other contracts might want you to report them on individual paylines with the RT and LT modifiers. You follow what the contract says- not what you do for all other payers.
Hope this helps
However, if you have a different contract with a different payer that does not pay venipucture according to contract- you do not have to bill it. It is not in your contract, and billing it just increases your A/R until you adjust it off.
There is no written policy that states if you bill one ins that way then you bill them all that way that I am aware of. Especially when dealing with commercial payers. Know what is covered and payable in your specific contract and stick to that.
For example, some payers contracts state to bill bilateral procedures with a 50 modifier, where other contracts might want you to report them on individual paylines with the RT and LT modifiers. You follow what the contract says- not what you do for all other payers.
Hope this helps
I am having the same question and I thought I remember somewhere down the line I was told to follow Mcare guidelines. If it was done, you bill for it, get a denial and then w/o appropriately. There are some instances where you know you are not going to get paid but still need the denial for a secondary insurance company or other reasons. I just can't find the documentation that supports it!!
jbrashear
Guest
Billing all payers the same
In my experience, I have learned that you should put all services provided during the visit on the claim. It doesn't matter if you put a dollar charge on it or not. Even though you aren't getting reimbursement for the venipuncture, it costs money (supplies, time, etc.) to provide it. If that cost is documented in a claim/insurance specific way, then your commercial insurance contract negotiator has leverage to negotiate payment for the venipuncture in the future. Hope this helps!
In my experience, I have learned that you should put all services provided during the visit on the claim. It doesn't matter if you put a dollar charge on it or not. Even though you aren't getting reimbursement for the venipuncture, it costs money (supplies, time, etc.) to provide it. If that cost is documented in a claim/insurance specific way, then your commercial insurance contract negotiator has leverage to negotiate payment for the venipuncture in the future. Hope this helps!
RFoster1
Guru
I agree with jbrashear.