Hi All,
I am new to the billing side of things. I work for and ASC/facility side of billing.
If we have a contract with a payer, and we perform a procedure that is not on the contract are we allowed to bill the patient as a non covered service? Or because we dont have an agreement to perform it with the payer, we cannot bill the patient?
We collect for cosmetic procedures because we know insurance wont pay for it, but thats a medical necessity issue ( I think). Meaning the code is on the fee schedule but they wont pay for it because its cosmetic/not medically necessary.
So the difference being the cpt code is just not on our contract with them, can we charge the patient?
thanks in advance
I am new to the billing side of things. I work for and ASC/facility side of billing.
If we have a contract with a payer, and we perform a procedure that is not on the contract are we allowed to bill the patient as a non covered service? Or because we dont have an agreement to perform it with the payer, we cannot bill the patient?
We collect for cosmetic procedures because we know insurance wont pay for it, but thats a medical necessity issue ( I think). Meaning the code is on the fee schedule but they wont pay for it because its cosmetic/not medically necessary.
So the difference being the cpt code is just not on our contract with them, can we charge the patient?
thanks in advance