Coding & Payment:
Primary Insurance:
99213: Paid $64.45 W/O $75.55
69210: Paid $23.58 W/O $41.42, $25.00 Pt Responsibility
Secondary Insurance:
99213: Paid $36.36, W/O 78.64, $25.00 Pt Responsibility
69210: $44.71 Patient Responsibility, W/O $45.29
The patient already paid the $25.00 copayment, however, both insurances paid the office visit at the contracted rate. In this situation, would this be considered an overpayment and we would then credit back one of the insurance carriers and, if so, which one? Or would this be each insurer paying at the contracted rate and we would keep each payment? Lastly, if we were to keep each payment, would we apply the overpayment to the patient responsibility for 69210, or would we collect the patient responsibility at the $44.71? Please help!
Primary Insurance:
99213: Paid $64.45 W/O $75.55
69210: Paid $23.58 W/O $41.42, $25.00 Pt Responsibility
Secondary Insurance:
99213: Paid $36.36, W/O 78.64, $25.00 Pt Responsibility
69210: $44.71 Patient Responsibility, W/O $45.29
The patient already paid the $25.00 copayment, however, both insurances paid the office visit at the contracted rate. In this situation, would this be considered an overpayment and we would then credit back one of the insurance carriers and, if so, which one? Or would this be each insurer paying at the contracted rate and we would keep each payment? Lastly, if we were to keep each payment, would we apply the overpayment to the patient responsibility for 69210, or would we collect the patient responsibility at the $44.71? Please help!