Frustrated

ajs

True Blue
Local Chapter Officer
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Tacoma, WA
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Okay Im very frustrated right now. Need some guideance. If I have a provider that documents a visit that supports a 99213 but he choses a 99212 due to this patient being a self pay.......how do I handle this? He states he doesn't feel its fair to charge a 99213 because there a self pay and this helps the community. We have a new PAC and his documentation supports a 99213 and he choses the level 99213. But the other provider that thinks every self pay should be a 99212 told the new PA that he shouldn't be charging a 99213 that he's over charging.

My thought is we should be charging what ever the document supports. Will I get into trouble for (through my cerftification)charging 99212 that the provider pickes when the document supports a 99213 if this was to be audited. Because the other side of this is the CFO said if the providers document supports a 99213 that better be what we are charging. So Im worried that my job will be on the line on both sides. Whats your thought??

Nichole:eek:
Correct coding states that you must code and bill for the level of service that is documented. The provider is allowed to offer a discount to cash paying patients as long as it is available to everyone. It is generally a good idea to not discount the fee to less than the Medicare allowed rate for that service. Most of the time between commercial payers and Medicare providers are writing off a portion of the fee anyway, so you can have a discount for cash paying patients. Maybe the provider will feel better about it if you set up a discount for self pay that is equal to (but not less than) the Medicare rate for each encounter code.
 

RonMcK3

Guru
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Greater Orlando
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Arlene,

Thanks for posting your reply (and quoting the original query) and your wise counsel. I imagine that it pops up not infrequently and it pits compassion against our efforts to encourage/enforce uniformity.

Thanks,
 

Grintwig

Expert
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Fayetteville, NC
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Two of our Docs charge self pay patient's the Medicaid rate and one uses the Medicare rate.
But they do this across the board for all selfpay patient's who are denied for Medicaid.
 

Deb2009

Networker
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Arlene,

Thanks for posting your reply (and quoting the original query) and your wise counsel. I imagine that it pops up not infrequently and it pits compassion against our efforts to encourage/enforce uniformity.

Thanks,


Pits our compassion against our efforts to encourage/enforce uniformity and Government Rules!! The providers seem to think we make these up as we go along. Frustrating, however makes me feel good that they think I can come up with this stuff!!! LOL :p I believe we all have the same frustrations.

If there is anyone that has documentation and direction on how we can get these issues across by making the providers think it is their idea (the only way we will get them on board) let us all know!!
 
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