different billed charges for same service

ramzeee68

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Does anyone know where I can find any documentation regarding billing different amounts for the same service or procedure?
 

honeybee

Networker
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Tempe, AZ
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I believe the AMA website will let you look up reasonable and customary fees for different CPT codes. Some practices also use the medicare allowable as a basis for their billed amounts.
 

CodingKing

True Blue
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I'm not sure of a source but I know you cant bill different prices to different carriers. You should set the rates and bill the same amount to all carriers
 

genenut

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North Conway, NH
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Per CMS rules you cannot charge different prices for the same service. You must bill everyone the same amount and the reimbursement can be adjusted to match your contract. charging different prices can get you in BIG compliance trouble.

So if you charge 50$ for a glucose test to one patient , you must charge the same amount to all patients. While Medicare may only allow 10.00 Cigna may allow 40.00. Its the contractual adjustment that changes the end "price".
 
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Does anyone have the CMS OOM? or OIG article? or anything that can support this. I have also been under this understanding but as a manager/compliance officer i need some hard evidence to enforce.
If anyone has a answer PLEASE email me at angelica.martinez@cphomes.net thank you
 

kuribe

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Bonita, CA
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The last post regarding this topic was in 2015. I would like specific CMS or OIG documents that prove this theory out! Does anyone have a link to this documentation?
 
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