Wiki Requesting HELP from the experts?

Create Wiki
Brandy0618

Brandy0618

Guru
Messages
103
Location
Mingus, TX
Best answers
0
:confused:.......I have what may be a dumb question....however, I have an excuse as IM NEW...LOL. Just passed my CPC on 2-23-13. I am doing some billing also where I work. We are in the transition from outsource billing to under our roof billing. My question is...When our patients that have HIGH deductibles pay toward this in our office at the time of service and we charge the "Allowable amount" but then insurance pays under the allowable amount, do we need to write off the difference or are we allowed to bill the patient for the difference. I feel like I may know the answer.....(we have to write it off), but would like to hear ADVICE from the PRO'S. Thank you so much for any help. I appreciate it. Brandy Blue-Smith
 
One of the reasons they could be paying less than the allowed amount is if they are leaving part of the amount to the patients deductible or coinsurance.

It should state on the remittance advice what they are leaving to patient responsibility. If you take less money at the time of service then what the patients max OOP is, then you can bill the patient. You have to provide the write-off they state on the remit.

Example:

Billed Amount - 2000
Allowable Amount - 1500
Insurance Paid - 1300
Left To Deduct - 200

If you only collected 100 from the patient due to a large deductible, you still need to bill the patient for the other $100. If you don't, that is lost revenue. When collecting from the patient upfront, I would suggest telling the patient, based off insurance processing, they could still receive a bill.

Hope this helps.
 
What does your contract say? Assuming you have one with the carrier, you would follow that, since they are reducing the billed amount.
 
If you are billing a carrier you have a contract with, the MOST you are allowed to collect from the carrier and patient combined is the allowed amount.
 
Brandy,

The allowed amount is the most you can receive. The difference from the allowable and the total billed has to be adjusted off. If the insurance pays less then what they allowed that is usually pt resp.
 
Thank you!!!

Thank you so much for all that replied to my questions. I cant tell you how i appreciate it!! :D;) Brandy
 
You must log in or register to reply here.
Top