Wiki Billing patients?

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coder_girl

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Does anyone know if it is legal to charge a patient for 99000 if the insurance denies it. It clearly states on the EOB that the patient may not be billed. One office I know of does this and says that they had the patient sign a waiver form. I was wondering if anyone knew if this was legal or not or how I could find out. Thanks!
 
You indicated that the EOB clearly states 'not to bill the patient'...i believe a write off apply...I would not bill the patient.
 
write off

The only caveat to the write-off would be if the provider is non-contracted. Then they would not be mandated to take an adjustment or not bill the patient for the non-paid amounts.
 
Billing pt's

I understand what you mean. I know for the fact that if the insurance company states do not bill pt, you do not bill the pt. This is when an ABN form is necessary. My boss does not want to use the ABN form, she states that the responsibility is the pt. She also states that the forms that the pt signs when they come in initially has information on financial responsibility of the pt. What I learned as an AAPC member is that we as coders have to do what is right and be careful.
 
I am concerned about the part of billing the patient if the office fails to get the claim out on time. I do not believe this is allowed practice. Yes the billing of the claims is a courtesy, but if you are a contracted provider then you are billing the claims as a part of the contract, and the patient has a right to rely on the provider to do so in a timely manner. If you fail to fulfill your end of the obligation you cannot automatically shift the burden to the patient after the fact. If your contract with the carrier states you are not to bill the patient then you may not bill the patient for that service or item.
 
I agree that it is wrong to bill the patients in this case if you are contracted. I have a feeling they are not contracted. If they are contracted there are some major issues, this is well beyond shady.

Laura, CPC, CEMC
 
i agree that it sounds unethical.. i know when the ins denies the 99000 we write it off. And exactly if it says do not bill patient, I wouldn't bill patient.

In other instances sometimes, we have the patient sign the back of our encounter form, if for any reason, such as certain vaccines, the ins may not pay for them... and by the patient signing if the ins doesn't pay for it & puts it out to the patient as a non-covered service, the patient has already signed and agreed to the fact that if the ins doesn't cover it, it is patient responsibility.
 
In what case would you use the 99000? I'm questioning because we draw the blood here in the clinic and send the specimen to other facility to be read?? But as far as I can tell no insurance co pays for the 99000, any help on this code would be appreciated.

Thanks ;-)
 
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