Bulletproof04
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I work for a Speech Path and Audiology clinic. The Executive Directors are circling around this in 2 areas. 1 employee discounts and 2 an issue where we are not contracted with a certain carrier but have several physicians wanting to refer their patients to us who have that carrier.
Topic 1: In the past they would provide services to employees bill the employee's insurance which is provided to the employee at 100% by the clinic and then write off the deduct and co-insurance. Upon discovering this I quickly informed them that they can do one of 2 things bill insurance and bill the employee their portion or no charge the employee. Am I correct in this? Can we offer a discount to our employees beyond insurance? What statue or guideline can I provide to back up my statement
Topic 2: Self pay rate for non-insured or out of network patients. It is my understanding that for any service or particular ICD10 code there should only be one charge amount? I understand that we can offer discounts for indigence on a case by case basis my question is if it is legal to offer a set self pay % discount. To back up my claim of having one charge amount I've been citing the Most Favored Nation Clause and the risk it poses the clinic if one of our contracted carriers would discover we have a reduced fee. Is there a statue or law that I can cite regarding billing a charge and offering a %discount?
I'm also having issues with the billing manager buying The Most Favored Nation Clause because they bill different hearing aids with different price points under one HCPCS code V5261, & V5257 and they are getting pd for it (I'm not saying this is right, just giving background information)
I appreciate any help you might provide or direction you might send me in.
Topic 1: In the past they would provide services to employees bill the employee's insurance which is provided to the employee at 100% by the clinic and then write off the deduct and co-insurance. Upon discovering this I quickly informed them that they can do one of 2 things bill insurance and bill the employee their portion or no charge the employee. Am I correct in this? Can we offer a discount to our employees beyond insurance? What statue or guideline can I provide to back up my statement
Topic 2: Self pay rate for non-insured or out of network patients. It is my understanding that for any service or particular ICD10 code there should only be one charge amount? I understand that we can offer discounts for indigence on a case by case basis my question is if it is legal to offer a set self pay % discount. To back up my claim of having one charge amount I've been citing the Most Favored Nation Clause and the risk it poses the clinic if one of our contracted carriers would discover we have a reduced fee. Is there a statue or law that I can cite regarding billing a charge and offering a %discount?
I'm also having issues with the billing manager buying The Most Favored Nation Clause because they bill different hearing aids with different price points under one HCPCS code V5261, & V5257 and they are getting pd for it (I'm not saying this is right, just giving background information)
I appreciate any help you might provide or direction you might send me in.