Wiki Non par reimbursement - ANY NON-PAR TRAUMA BILLERS

[bill2doc]

Billing for non-par trauma doc's for professional services. Kaiser paid for a pt in full for my billied 99291 but not in full for my 99292 as they stated paid by customary and resonable fee and noted an adjustment.

Anyone billing for non-par. My understanding was they should be paid in full as they are not participating and under no contract. I don't know how to know what the reasonable/customary fee is.... Can I appeal ? Can I balance bill the patient.

practicing in California

Thanks for your advice

 

[ajs]

Billing for non-par trauma doc's for professional services. Kaiser paid for a pt in full for my billied 99291 but not in full for my 99292 as they stated paid by customary and resonable fee and noted an adjustment.

Anyone billing for non-par. My understanding was they should be paid in full as they are not participating and under no contract. I don't know how to know what the reasonable/customary fee is.... Can I appeal ? Can I balance bill the patient.

practicing in California

Thanks for your advice

Non-par generally means you are not required to accept reasonable and customary as payment in full, you can balance bill the patient for the amount not paid by insurance.

 

[CLCameron]

In addition to balance billing the patient, you can send your claim back for reconsideration/appeal. Ours generally emphasize the emergent nature of treatment and outline that the patient had no choice to accept our provider and should not be penalized for the lack of available contracted providers.

Additional reimbursement has varied based on who is reviewing the reconsideration/appeal and is usually more successful with patient involvement.

Good luck