Practice Management Alert

Question: If a patient is self-pay, do global surgical packages still apply? Can we bill self-pay patients for post-operative visits?

- New Hampshire Subscriber

Answer: Global surgical package rules do not apply to self-pay patients, therefore you can charge for postoperative visits if you wish.

Insurance carriers use global surgical packages to simplify billing and reimbursement. When you bill one code for a surgery, the fee the carrier will pay for that code includes the cost of all expected post-op visits. Consider billing self-pay patients in the same way to simplify things for both the patient and your billing office. For example, if a surgery costs $6,500, you may want to charge the self-pay patient one set $7,000 fee that will include all post-op care.

Piecemeal: Your other option with self-pay patients is to charge them piecemeal for each separate service the physician renders. This method may be more profitable if you have a complicated patient who returns for more post-op visits than normal.

Watch your market: When determining how to charge self-pay patients, don't take it too far. First consider how competitive your practice is within your specialty and your geographic area. If you command the market, you may be able to charge more for your services. However, if you have considerable competition, you need to be careful not to price yourself out of the market by charging exorbitant fees.