jbmcelrath
New
I have a providing stating she does not need to follow teaching physician guidelines for commercial and self-pay patients. Is that correct?
Which guidelines is she referring to as not needing to be followed?
For commercial patients, the provider would need to follow any guidelines stipulated in any contracts the provider has with that payer. Self pay patients, theoretically at least, can be billed for services as the provider sees fit since no claims are being generated and therefore nothing is being coded.
It may be possible to 'get away' with something like this, but it's inadvisable to treat different patients differently based on coverage or ability to pay. After all, a patient may have coverage that the provider is not aware of at the time of service, or may in some cases retroactively get coverage, and then the provider, by not following the guidelines, would be putting herself in a position of being at risk for having inappropriately documented or billed something that did not meet a payer's requirements. I don't understand why any provider would selectively observe certain guidelines only for certain types of patients - it just makes no sense to me when I hear something like this.