billing for specialist

apena

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We are billing for OB/GYN, ENT, and also FP (who also practice OB), my understanding is that we can bill more for the specialist services, then a FP.

Can someone please, let me know if I am correct.
 

btadlock1

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We are billing for OB/GYN, ENT, and also FP (who also practice OB), my understanding is that we can bill more for the specialist services, then a FP.

Can someone please, let me know if I am correct.
You may be reimbursed more for a specialist's services than for a FP doctor's, but that will depend on your providers' payer-contracts. More than likely, you will receive the same allowed amount for a given service, but the patient's cost sharing amount (eg, copay) will be higher with a specialist.

Specialists tend to get higher reimbursements for services like office visits, for example, because their patients frequently require more extensive evaluation/management work (on average), than the typical patients for an FP provider. Also, they perform more specialized services than FP doctors, which are usually more expensive. (For example, interpreting a fetal ultrasound, pays more than interpreting a chest x-ray).

So, I guess the answer you need is, check your fee schedules with your payers, and bill accordingly. Hope that helps! ;)
 
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