Wiki Charging patients for non covered services

[bertascc@gmail.com]

I work in a chiropractic office in Florida. The only covered service under Medicare is a spinal adjustment. My questions are:
If we are out of network, do we charge our regular fees for the non-covered services or do I need to charge what the medicare allowable is for those CPT codes?
Also, if the patient has a Medicare advantage plan under another health ins co, are we required to bill for the adjustment regardless if we are not participating with that advantage plan?

 

[OpenClaims]

I work in a chiropractic office in Florida. The only covered service under Medicare is a spinal adjustment. My questions are:
If we are out of network, do we charge our regular fees for the non-covered services or do I need to charge what the medicare allowable is for those CPT codes?
Also, if the patient has a Medicare advantage plan under another health ins co, are we required to bill for the adjustment regardless if we are not participating with that advantage plan?

If you are out of network you would charge a "good faith estimate" of what the patient would expect to pay. This could be the Medicare allowable if this is what your office policy states. Also, the Medicare advantage plan may have out of network benefits. So you could send the secondary claim with the patient resp from the primary EOB or create a good faith estimate since you are out of network with the secondary. If any of your denial codes (if denied) deny with a CO you cannot drop this to patients resp. The processing code will have a PR which means it is the patients responsibility.