annawade13
Networker
This question is related to the "multiple fee schedule" question.
Can we legally charge one price to a private pay patient and a different price to a Medicare beneficiary? My specialty is optometry/ophthalmology. Our comprehensive exam code 92014 is set at around $115 for Medicare; however, our doctors only want to charge $89 for a "routine" eye exam including refraction, and justify it by saying we can use the S-Codes (S0621). BUT, my compliance officer says the OIG will take into consideration "like procedures" when determining whether we are overcharging Medicare beneficiaries, and therefore the routine vision exam and medical vision exam need to be the same price.
I have the same question regarding retinal photography (92250). Our doctors like to do this test as a screening, in the absence of medical necessity. Can they legally charge a patient a "screening" fee that is lower than Medicare's allowed amount? Medicare allows around $70 for this test but the docs only want to charge $29 when done as a screening. There is no cpt code for retinal photography screening, so we would have to make one up and never bill it to insurance, I'm guessing.
We have been arguing this problem back and forth for a year- help!
Can we legally charge one price to a private pay patient and a different price to a Medicare beneficiary? My specialty is optometry/ophthalmology. Our comprehensive exam code 92014 is set at around $115 for Medicare; however, our doctors only want to charge $89 for a "routine" eye exam including refraction, and justify it by saying we can use the S-Codes (S0621). BUT, my compliance officer says the OIG will take into consideration "like procedures" when determining whether we are overcharging Medicare beneficiaries, and therefore the routine vision exam and medical vision exam need to be the same price.
I have the same question regarding retinal photography (92250). Our doctors like to do this test as a screening, in the absence of medical necessity. Can they legally charge a patient a "screening" fee that is lower than Medicare's allowed amount? Medicare allows around $70 for this test but the docs only want to charge $29 when done as a screening. There is no cpt code for retinal photography screening, so we would have to make one up and never bill it to insurance, I'm guessing.
We have been arguing this problem back and forth for a year- help!