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Self Pay to Insurance

  1. #1
    Question Self Pay to Insurance
    Medical Coding Books
    If a patient self pays for a procedure, but then later requests that it be submitted to their insurance, are we obligated to submit it to insurance? The doctor had the patient self-pay because he thought there was no medical nec. In addition, we did didnt complete any type of pre-determination, and its past timely filing.

  2. #2
    No, you are not obligated. However, I do require my patients to fill out the cash patient waiver form which spells out that we will not bill insurance and they have the option to have this portion of their visit blinded from 3rd party requests.

    I would recommend having a form to protect you in the event. Also, you might want to check with your provider agreement. Some plans REQUIRE you to bill the insurance. If you have the form in place, you can cover yourself/practice from any violations the payor may impose.
    [COLOR="Blue"]Kandy Morris CCS, CCS-P, CPC, CPB, CPC-I, CPMA, CEMC, CPOC
    AHIMA-approved ICD-10CM/PCS Trainer & Ambassador
    AAPC PMCC Approved Instructor

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