AAPC - Back to school
Results 1 to 3 of 3

Thread: Billing question

  1. #1

    Lightbulb Billing question

    AAPC: Back to School
    Practice where I work we have different providers what I mean by that : we have a sport medicine doc, internal medicine doc , APRNs, PAs, specialists (obgyn, surgery )When it comes to payments form for example anthem each provider would get different amount of payments for the same E/M codes . Does anyone know why??? does it have anything to do with their crudentials ?
    thank you

  2. #2
    Join Date
    Apr 2007
    Dover Seacoast New Hampshire


    It depends on your contracts with your payers. CMS pays midlevels at 85% of the physician allowable, and some payers will reimburse specialists differently. Smaller practices typically get paid based on an established fee schedule, but if you are a bigger facility,or associated with a PHO, sometimes you can use their clout to negotiate a better reimbursement.

    If your software supports it, you should load your fee schedule, by payer, and by provider so that you can verify when you post payments that you are being paid correctly based on that payer and depending on who provided the service. Payers make mistakes, and if you're not aware of your contracted allowance, you could be writing off dollars that you are entitled to.
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  3. #3


    In multiple specialty group practices the group or the provider has a contract
    with the PPO or HMO. So you need to look at your contracts. Also the PA will get paid at a lower % rate than the Physician.

    That has been my experience with billing in our practice.


Similar Threads

  1. Billing Question
    By acosta6 in forum Billing/Reimbursement
    Replies: 1
    Last Post: 01-30-2015, 01:20 PM
  2. Billing Question
    By tcoder5 in forum Podiatry
    Replies: 4
    Last Post: 08-26-2013, 06:20 AM
  3. Replies: 1
    Last Post: 11-02-2010, 08:54 PM
  4. billing question
    By paula f3 in forum Anesthesia
    Replies: 3
    Last Post: 10-10-2009, 02:39 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.