Wiki Out of Network Balance Billing

[Cavalier40]

I work for a substance abuse billing company in which our clients are 100% out of network will all insurances. They do not bill Medicare since free standing substance abuse facilities are a non covered entity.

My companies policy is to balance bill everything (unless the price was negotiated by a 3rd party pricing company like Multiplan)

I have argued to my superiors that since we check yes on provider accept assignment on our claims that we are allowed to write off the balance up to the out of network allowable or usual and customary rate (which can be calculated on any remittance) My superiors say that is fee forgiveness. I disagree. Shouldn't we be able to write off the balance bill as long as we bill the patient the deductibles, copays and coinsurances that are assigned by the payer?

 

[CodingKing]

You would need to bill whatever the patient responsibility is on the EOB. If you are non-par i'm not sure why there would be any write off amount listed on the EOB.

 

[Cavalier40]

Well there are reasons to have a CO45 w/o on the EOB depending on how it was priced and who priced it. But those are usually negotiated agreements.

I can see why you would say to bill the patient what is on the EOB, but I am wondering about the legal obligation to do so without violating anti-kickback.

For example. If a facility bills a procedure at $100 and BCBS allows $20 and has a 50% coinsurance, we would get a payment of $10. Only the 50% coinsurance will be applied to the patients out of pocket max. So why would it be fee forgiveness if we only drop a $10 balance to the patient and write off the other $80, especially if we accept assignment on the claim form?

I ask because part of it is psychology. Would you be more likely to get payment on a $10 bill or a $90 bill?