Wiki Lower charges for Self Pay Patients

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csanchez6

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Are there any consequences to under-coding cases for self-pay patients? For example, if we have a plastic surgeon that does about five breast reduction cases a year, rather than charging an 88305, there is a proposal to down-code to a 88304 so the patient doesn’t have to pay as much. Would this conflict with any Medicare rules and regulations?

Thank you.

Cathy
 
This is generally not advised. If an insurance company who did cover a portion of the same procedure found out that they had been charged more for the service, they would have grounds to sue for the difference.
 
What we do is bill out the correct code and amount and then take a self pay discount, that way if the patient actually had insurance and we did not know it all we have to do is take the discount off. This also shows what was REALLY done in the office. If you down code it's telling a false story and I personally don't think that is right.
 
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