CatchTheWind
Guest
When in-network, I know it is common (and allowed) practice to inflate the charges sent to the payer and then write off the amount that is greater than the contracted rate.
But when you are out-of-network, I had learned somewhere that the most you can charge the payer is the amount you have agreed to accept from the patient. Let's say, for example:
Your charge is $150.
Patient A has in-network insurance which allows $100, so you send a claim for the full $150 and then write off $50.
Patient B has an out-of-network plan, and you've agreed to accept $120 as payment in full at the time of service from the patient, but you will file a non-assigned claim in the hope of getting him some reimbursement. Is it true that you cannot send a $150 claim, only a $120 claim? This is what I had learned, but I cannot find the source!
But when you are out-of-network, I had learned somewhere that the most you can charge the payer is the amount you have agreed to accept from the patient. Let's say, for example:
Your charge is $150.
Patient A has in-network insurance which allows $100, so you send a claim for the full $150 and then write off $50.
Patient B has an out-of-network plan, and you've agreed to accept $120 as payment in full at the time of service from the patient, but you will file a non-assigned claim in the hope of getting him some reimbursement. Is it true that you cannot send a $150 claim, only a $120 claim? This is what I had learned, but I cannot find the source!