injections and medication billing


Dawsonville, GA
Best answers
I am in a new office and I am questioning how they bill their injections and medications. For medications that are covered at a below cost amount at reimbursement through insurance companies (like rocephin, decadron, toradol) this office is not filing the J-code and just charging the patient a flat fee out-of-pocket. I told the physician I was concerned that this was not a proper procedure because the medication is "covered", it is just not covered at a rate that covers our cost. I believe we have an obligation per our contract with the insurance companies to file the medication and accept what they reimburse us even if it is 4 cents. Understand...this is not double dipping. The patient is being charged and the insurance is NOT filed. I would like to know if there is anyway to bill injections and medications to cover the cost. I understand that if the medication is deemed "non-covered" we can bill the patient. This is such a dilemma for me...I hope someone can share their office procedures.
If you bill for the meds/immun along with the admin codes (96372, 90471-90472) this should make up some of the cost.