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Self Pay Patients

  1. #1
    Unhappy Self Pay Patients
    Medical Coding Books
    I need someone with a background in law (or an article written by someone with a law background). I have been put in charge to find an answer to a question that everone is in disagreement on in my company. Can you bill a self-pay patient less than the Medicare allowable in the state of Oklahoma? We have patients coming in for eye exams with no insurance or no vision care coverage and we are charging a flat fee of $80.00. The medicare allowable for a 92014 is $95.12 and the allowable for the 92012 is $64.90. I have some telling me we can charge the flat fee of $80.00, others are saying we should bill all self-pay patients the 92012 code regardless of the work we do. I am not finding what I need and am really desperate for an answer. Can anyone help, please?

  2. #2
    Columbia, MO
    You may not charge less than Medicare and you may not undercode the encounter. If the patients have no insurance then you should obtain the OK medical indigency provision which will tell you based on their income how much you may discount from your fee schedule for self pay. Usually this comes from the state HHS office.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Milwaukee WI
    Default Written policy Uniformly applied
    You need a written policy in place to deal with patients with financial hardship. And you then need to uniformly apply that policy to all patients.

    The charge will be the same for everyone. The adjustment/write-off may vary (just as it does for different payers, depending on your contracts).

    Our financial hardship applications require considerable proof of income and expenses (tax records, rent receipts, etc). We have had patients eligible for 100% financial hardship write-off. We occasionally have a patient unwilling to provide the required proof. That is that patient's right, of course. In those cases, the bill goes out at full fee and we aggressively pursue payment up to and including collection agency referral, just as we would for any other patient.

    The key is that you must have a written policy in place and you must apply it uniformly to all patients.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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