Results 1 to 3 of 3

Non par reimbursement - ANY NON-PAR TRAUMA BILLERS

  1. Default Non par reimbursement - ANY NON-PAR TRAUMA BILLERS
    Exam Training Packages
    Billing for non-par trauma doc's for professional services. Kaiser paid for a pt in full for my billied 99291 but not in full for my 99292 as they stated paid by customary and resonable fee and noted an adjustment.

    Anyone billing for non-par. My understanding was they should be paid in full as they are not participating and under no contract. I don't know how to know what the reasonable/customary fee is.... Can I appeal ? Can I balance bill the patient.

    practicing in California

    Thanks for your advice

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by bill2doc View Post
    Billing for non-par trauma doc's for professional services. Kaiser paid for a pt in full for my billied 99291 but not in full for my 99292 as they stated paid by customary and resonable fee and noted an adjustment.

    Anyone billing for non-par. My understanding was they should be paid in full as they are not participating and under no contract. I don't know how to know what the reasonable/customary fee is.... Can I appeal ? Can I balance bill the patient.

    practicing in California

    Thanks for your advice
    Non-par generally means you are not required to accept reasonable and customary as payment in full, you can balance bill the patient for the amount not paid by insurance.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Default
    In addition to balance billing the patient, you can send your claim back for reconsideration/appeal. Ours generally emphasize the emergent nature of treatment and outline that the patient had no choice to accept our provider and should not be penalized for the lack of available contracted providers.

    Additional reimbursement has varied based on who is reviewing the reconsideration/appeal and is usually more successful with patient involvement.

    Good luck
    C. Cameron, CPC
    Billing & Coding Manager

Similar Threads

  1. New Acupuncturist NON PAR
    By ajijon in forum Payer/Health Plan
    Replies: 1
    Last Post: 03-08-2014, 01:17 PM
  2. Non par reimbursement - ANY NON-PAR TRAUMA BILLERS
    By bill2doc in forum General Surgery
    Replies: 6
    Last Post: 02-12-2013, 01:58 PM
  3. Replies: 1
    Last Post: 12-20-2011, 04:05 PM
  4. Non par reimbursement - ANY NON-PAR TRAUMA BILLERS
    By bill2doc in forum Emergency Department
    Replies: 2
    Last Post: 12-20-2011, 03:57 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?

Login

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.