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Dollar Amount and 90471

  1. Exclamation Dollar Amount and 90471
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    Question: I do the billing for a Hospital Owned Clinic, and we have a legal question for anyone out there. I'm not sure if the billing guidelines are slightly different from a privately owned practice. I was under the understanding that you had to bill the same dollar amount to "everyone". We are having an issue with VFC vaccinations and the state. Is it accurate to charge different prices to different companies/self-pay? Our charge is $28 dollars for the administration for private insurance companies and $10 to medicaid/ma-medicaid/self-pay patients. This is confusing to me.

  2. #2
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    It is my understanding that you can charge whatever you like, as long as you don't bill Medicare MORE than anyone else.
    Walker Bachman, CPC, CPPM

  3. Default
    Are the billing guidelines and rules any different for a hospital owned clinic than a private practice??

  4. #4
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    Quote Originally Posted by tkrame01 View Post
    Question: I do the billing for a Hospital Owned Clinic, and we have a legal question for anyone out there. I'm not sure if the billing guidelines are slightly different from a privately owned practice. I was under the understanding that you had to bill the same dollar amount to "everyone". We are having an issue with VFC vaccinations and the state. Is it accurate to charge different prices to different companies/self-pay? Our charge is $28 dollars for the administration for private insurance companies and $10 to medicaid/ma-medicaid/self-pay patients. This is confusing to me.
    Actually you need to check with your VFC rep. whatever medicaid allows is all you can charge anyone that you use your VFC stock for. Here in utah Medicaid allows $12.51 so we chose to charge are VFC self pay patients $12 to make it easier (you can charge less but not more) and its that amount per shot.
    Jody Thompson, CPC

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