Wiki Billing insurance for pre-op and post-op visits for a cash pay surgery

[Khart8]

One of my providers posed this question.

A pt has a surgery done and must pay cash (for denial, elective surgery, etc.). Other specialists practices are telling us they are still billing the pt's insurance for the pre-op and post-op visits. (Even those w/in the global period). He asked if it would be "correct" to bill this way.

I told my provider that I was uncomfortable doing this, because even though the pt paid cash, I feel it is still a global charge and I am also afraid that if we were audited we would get cited for not billing equally to all of our patients.

Thoughts?

 

[thomas7331]

I agree with you and would also be uncomfortable with it. In this situation, you could theoretically reduce the patient's surgical charge to include only the intra-operative services and exclude the charges that are global, thereby making your charges equal for all patients. However, I would not recommend this because it seems to me that the insurance that is paying those global charges is likely doing so in error because if they have denied the surgery, then the inclusive visits should not be billed or paid either. If they were to audit those visit notes, I think it is quite likely that they would recover those payments and you would be back where you started anyway. The best practice, in my opinion, is to have the patient pay the global charge and not 'double-dip' by trying to get the peri-operative care through underneath the payers' radar.