CCMB
Contributor
Question: My office bills all insurances the same amount, which I understand to be correct but what I am looking for is something documenting this for an appeal. Can anyone help with this?
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Wiki Fee Schedules
- Thread starter CCMB
- Start date
SharonCollachi
Guest
What are you appealing??
Frankly, you CAN bill each insurance a different amount. It's wrong, and I'll tell you it's wrong, and I'll tell you that you shouldn't listen to anyone who says otherwise!!
Why is it wrong? Because if you bill Anthem $100 for a procedure and you bill Medicare $150 for a procedure, Medicare will tell you that your usual and customary amount is not in fact $150. If the fee schedule allows $130, then Medicare can come back and say, but you only billed Anthem $100 for the same thing, so THAT is your regular fee, and that's all we're going to allow. So you just lost $30.
Also, if you bill a different amount to out-of-network plans, then you're telling them your usual and customary is not that rate. Wayyyyyy back in my 20's, my insurance tried to tell me that the usual and customary for a procedure in my town was, say $100, and that's all they were going to pay. My doctor billed $250, and since it was out of network, I was responsible for anything insurance didn't pay. I successfully won on appeal, because my doctor was the ONLY doctor in the town doing that procedure, so the "usual and customary" for that area was EXACTLY what she was billing.
Frankly, you CAN bill each insurance a different amount. It's wrong, and I'll tell you it's wrong, and I'll tell you that you shouldn't listen to anyone who says otherwise!!
Why is it wrong? Because if you bill Anthem $100 for a procedure and you bill Medicare $150 for a procedure, Medicare will tell you that your usual and customary amount is not in fact $150. If the fee schedule allows $130, then Medicare can come back and say, but you only billed Anthem $100 for the same thing, so THAT is your regular fee, and that's all we're going to allow. So you just lost $30.
Also, if you bill a different amount to out-of-network plans, then you're telling them your usual and customary is not that rate. Wayyyyyy back in my 20's, my insurance tried to tell me that the usual and customary for a procedure in my town was, say $100, and that's all they were going to pay. My doctor billed $250, and since it was out of network, I was responsible for anything insurance didn't pay. I successfully won on appeal, because my doctor was the ONLY doctor in the town doing that procedure, so the "usual and customary" for that area was EXACTLY what she was billing.
Jessuhkuh099
New
Is there a way to export your fee schedule or send them a spreadsheet of it? odd they are asking for proof..suspicious..