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charging for self pay

  1. Default charging for self pay
    Medical Coding Books
    I live in KY and my nephew lives in NY. (Because i don't know if rules vary state by state.) He went to the doctor, he is self pay and was initially charged a level 1 visit. When they discovered he was self pay, they changed their billing to a level 3. When questioned about this, their reply was they bill all self-pay a level 3. Obviously, being self pay, this is more out of his pocket. Now..I know first off the documentation has to be there to warrant a level three. That will be what I check out first for him. But my question is, can they just arbitrarily charge every self-pay a level 3?? I mean nothing about this makes sense to me, but he asked for my help... I don't understand how they can just charge a level 3 because he's self-pay. Any ideas? I appreciate all help!

  2. #2
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    No they cannot flatly charge everyone who is a self pay at a level 99213 for a sick visit. The documentation drives the e/m charge. Are you a certified coder?? I would call this office and inform them you know that the level of this visit is drawn from the drs documentation in the medical record and not driven by the insurance or lack thereof. Just my opinion but i have never heard of such a thing! Good luck

  3. #3
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    Columbia, MO
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    Helen is correct there cannot be an arbitrary fee for self pay. The documentation drives the visit level and the fee schedule drives the charge. To do different is construed as possible misrepresentation or discrimination or a whole host of other statute violations.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
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    I agree get the documentation. I'm a biller/coder in a speciality office in upperNew York State, Ability to pay should not influence charges, documentation is the only thing to influence evaluation and managment services. Good luck

  5. #5
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    I agree.. they cannot just charge every self pay patient a level 3 office visit...the documentation must be in the medical record... some patients may go into office with a simple cold, needs antibiotic and is finished, while other patients may come in with a complicated cold, need additional work up and treatment, all should be documented and then billed appropriately.

    our doctors will bill appropriately and sometimes not charge the patient for the full amount that we charge for the level of service ..they are willing to sometimes write off a small amount of the charged amount.

    i would let that office know, absolutely.

  6. #6
    Default
    I agree get the documentation. I'm a biller/coder in a speciality office in upperNew York State, Ability to pay should not influence charges, documentation is the only thing to influence evaluation and managment services. Good luck

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