Wiki No insurance, EM+ procedure

[SUN1633]

Hi,
Our practice wants to offer discount rates on office visits and procedures for those patients without insurance. We have a concern on billing correctly.
Example: If filing insurance: A procedure is performed (no separately identifiable EM) then only the procedure would be billed to insurance and not an EM level.
In the same scenario, when no insurance is being filed, the practice wants to charge for the visit charge and procedure charge at a discounted rate and feel this is allowed because insurance is not a factor- the patient would sign a form showing charges ahead of time that we charge a standard visit fee and any additional procedures will be charged separately.

Is this allowed? Or would billing have to be the same/ follow the same rules whether filing insurance or not?

 

[julieordway]

Establish a self pay fee schedule. If you normally wouldn't charge for a procedure and OV, then I would follow the same principle when billing self pay patients.

 

[thomas7331]

I agree, the best and fairest practice is to treat all your patients equally. From a compliance perspective though, if you’re not billing any claims, the payment arrangement between the provider and a self-pay/uninsured patient would likely be considered a mutually agreed private contract between the two parties and not subject to the usual coding and billing rules.