Wiki How to handle covered/noncovered services?

[suemt]

Looking for some guidance or best practice on how to document, code, bill, etc. when a patient has some services the insurance pays for, along with services the insurance will not pay for and the patient is willing to pay for separately.

I've got providers who are handling this differently and I'm looking to how other handle this, and also if there are any formal guidelines or instructions available on this.

I believe the documentation should be the documentation and should reflect the complete service that was provided, regardless of whether or not insurance will pay for some of all of it.

How to bill for it is another story. For example, if one procedure is covered but another isn't, do you just bill for the covered procedures? What if one side is covered but not the other (RT vs. LT)?

Thanks in advance for any feedback. I sincerely appreciate this group and all the knowledge you have and share!

 

[CatchTheWind]

I agree with you 100% regarding the documentation. Everything has to be documented - no exceptions!!!

As for the billing, that's optional; you can bill if there is any possibility of getting paid, or if the patient needs a denial to send to a gap plan. Otherwise, you don't have to.

Also, if the patient has Medicare or a Medicare Advantage plan, be sure to get an ABN even if you know it won't be covered, unless it is cosmetic or something else that Medicare does not cover under any circumstances. (If you don't, and the patient tells Medicare that you collected payment from them, Medicare can require you to refund it to him.)