Practice Management Alert

Question: My doctor spends a good deal of time on confirmatory consultations, which I bill with a 32 modifier. No matter what insurance I bill, they only pay the allowed amount. Should I even bother with the 32, if it doesn't make a difference?                                                                              Mississippi Subscriber  Answer: Yes, you should bother with 32, but it's not going to make a difference to your reimbursement.      Simply put, insurance companies are usually going to pay only their allowable amount. "There's no way I know of to increase what you receive other than to refuse to participate with the insurance plans that are paying you the allowable amount under their plan," reports consultant Quin Buechner, MS, M.Div, CPC, CHCO, president of ProActive Consultants in Cumberland, Wis. You can charge as much as you want to on the bill, but you can't actually make the insurance company pay more than the allowable. "The only way to beat that is to not participate in any of those insurance contracts," he says. What you can do, provided your state laws and your payor contracts don't have any provisions to the contrary, is to bill the insurance company for the fee you see as being appropriate, take the allowable from them, and bill your patient for the difference. Of course, "this has the potential of giving you bad press" and drying up referrals, Buechner warns. And using the 32 modifier (services related to mandated consultation and/or related services) won't make any difference when it comes to payment. "Its essentially an informational modifier, not truly effecting payment," Buechner explains. Nonetheless, you should use it as appropriate "for correct coding purposes," he advises.