Wiki Coding levels

[raidaste]

I've got an ARNP who seen a pt that's selfpay. Our policy is to collect for a level 3 visit up front prior to being seen and then balance bill any remaining charges. The documentation of that visit is a level 4 and not level 3, but because the pt was told amt for the level 3 the provider doesn't want to up the level to a 4 (this is a very regular pt). How would you handle this, because I don't want to bill/code incorrectly?

 

[dwaldman]

The way we do it at the practice I work at is they follow the 3 year rule in regards to new or established patients. They have a set fee for a new patient and a set fee for an established patient for cash discounted pricing for patient that do not have health insurance. The level of service is billed and then a cash discount adjustment is taken for the remaining balance. If your level 2, 3 4 in your chargemaster is more than the cash discount prices than regardless which level the doctor's documentation meets the patient pays a set fee for say an established patient then an adjustment is taken. Since they have a set fee they can charge for the visit up front at the front desk and they do not have separate fees for separate levels for cash discounted pricing which would require payment following documentation completation.