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Billing Insurance (Fees)

  1. #1
    Location
    Marion, OH
    Posts
    43
    Talking Billing Insurance (Fees)
    Medical Coding Books
    We recently signed a new contract with one insurance company that gives us an enhanced fee for procedures done in the office. I have always heard that you should bill all insurance the same rate. My question is, if we need to raise our fees because of this enhanced fee, do we raise it for just the one insurance company or across the board?

  2. #2
    Location
    Tuscaloosa, AL
    Posts
    92
    Default
    We have one set fee (or charge) for a procedure with different allowables based on our contracted insurance's fee schedule.

    Jerri

  3. #3
    Location
    Marion, OH
    Posts
    43
    Default
    That is how we are currently billing but some of the enhanced fees would increase office procedures by $100 to $400. Do I legally have to bill all the same and just adjust off more for the ones without the enhanced fee or can I just bill the one insurance company more?

  4. #4
    Default
    Many insurance contracts have wording that covers this situation. It boils down to you can't bill them anymore than you would anyone else for the same service.

    If you want to increase your rates for the one, you should for everyone else as well.

    As far as the legality, I don't know. Ethically it would be wrong to charge some people more because of the type of insurance they have.

    Laura, CPC, CEMC

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