Wiki Self pay patients

[Shawna Paul]

I was asked to query my AAPC group regarding the following:

If a patient is a seen by a midlevel (PA, NP) insurances normally pay at a lower rate than if the patient saw an MD or DO. For those patient's who are "self pay" and see a midlevel do you adjust their charges to be at a lower rate that would be consistent with what an insurance company would pay for the visit?

Thanks for any responses to this question.

Shawna Paul, CPC

 

[mcnaryk]

I was asked to query my AAPC group regarding the following:

If a patient is a seen by a midlevel (PA, NP) insurances normally pay at a lower rate than if the patient saw an MD or DO. For those patient's who are "self pay" and see a midlevel do you adjust their charges to be at a lower rate that would be consistent with what an insurance company would pay for the visit?

Thanks for any responses to this question.

Shawna Paul, CPC

Hi Shawna,
I don't know if there are any "set rules" when it comes to self pay patients; I think it's up to the individual practices. But in my experience, our doctors would ask the self pay patients to pay (up front) the amount Medicare would've paid on the procedure/visit for one of their beneficiaries. So not much, but no less than what we accepted from Medicare. If your doctors don't want to go that low (and I don't blame them!), to answer your question, yes I would charge a lower rate for a PA/NP visit. I hope this helps!

 

[Shawna Paul]

Thanks for the information.

Shawna Paul, CPC