In my 20+ years working in billing and coding I've never encountered any payer that used taxonomy codes as a factor in payment calculations. You'd need to look at your provider's contracts with the payers to know for sure, but I would be very surprised if putting a different taxonomy on the claim would make any difference in your reimbursement.Has anyone seen a different / higher level of reimbursement when billing out a different taxonomy code? For example if we billed total joints out using the adult reconstructive orthopedic surgery taxonomy code - would that get us a higher reimbursement than billing our general orthopedic taxonomy code?
Thomas that has been my experience as well. My office manager is stating that MGMA says different. I have not been able to find anything to say it will increase reimbursement but am needing so back up on my end. Thank you for responding!In my 20+ years working in billing and coding I've never encountered any payer that used taxonomy codes as a factor in payment calculations. You'd need to look at your provider's contracts with the payers to know for sure, but I would be very surprised if putting a different taxonomy on the claim would make any difference in your reimbursement.
It's possible that the MGMA is saying that the taxonomy will figure in the rates that are allowed to the provider during contract negotiation. I don't know though - I would ask your manager to see the source information from the MGMA for clarification. Once a contract is in place, though, the rates are usually set in stone. Unless the contract specifies that your provider has a different set of rates for their different taxonomy codes, it's not going to change anything. And honestly, I don't think most payers' claims systems even have the programming capability to implement different rates for different taxonomies.Thomas that has been my experience as well. My office manager is stating that MGMA says different. I have not been able to find anything to say it will increase reimbursement but am needing so back up on my end. Thank you for responding!