Wiki Not billing according to physician rate

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amskirvin

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Hi,

I'm a new biller and I was not billing according to my physician's hourly rate of $150 per hour. I was only billing the rate that I knew she would get paid for. My question is: Can she still take the contractual write off even if I didn't bill the full amount of her rate?

I know I didn't do right, but I didn't know if I could take the contractual adjustment retroactively.

Thanks,
Ann
 
Sorry. I shouldn't have used the word physician.

I work in behavioral health. I work for a therapist. Her preferred rate is $150 per session. That's a better way of putting it. I didn't know that I should've been billing the $150 and doing a contractual adjustment for the rest. I'm billing the insurance companies and Medicaid.

I guess my question is: can I do an adjustment on the books retroactively even if I didn't bill the full amount?

Thanks,
Ann
 
So she charges $150 for each session no matter how long it is, no matter what code?? He/She should really sit down and assign a rate to each code.

I believe you would have to submit corrected claims for the correct billed amount. I'm assuming the write off's are tax deductible to some point. I assume if the practice were audited by the IRS, you would need backup documentation of the write-off (EOB)
 
You may go back and bill with the correct rate depending on how long ago the claims are for. The write off amounts are generally NOT tax deductible if your therapist is an S corporation as she is fee for service. CodingKing is correct that each code should have a set amount and that is the amount that you charge each and every insurance. To do otherwise is insurance fraud. Now as Medicaid uses HCPCS codes to bill with you may assign a different amount to them vs the reimbursed rate for say 90791, 90837 etc. Keep in mind that if your cash pay price is less than or different than what you bill insurance, justification should be given as to why this is to avoid insurance fraud appearance. In our office we use a sliding scale based on household size and income to justify a lower cash pay price, however full price is based on the actual rates we charge insurance. Also, for billing reasons, make sure that start and stop times as well as session length match and are documented as well as supported by the diagnosis.
 
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