Wiki QK billing

[warrior11209]

My office is having problems when using the QK modifier. We are reducing the fee schedule amount by 50% prior to submitting claims to our various TPA's and are receiving an additional reduction on the reimbursements. When I appeal the decision, the payors and inquire why the allowed amounts were slashed an additional 50% I am being told that it is not a Medicare guideline just common sense not to reduce the billed amount prior to submission. Can anyone supply me with a source which states the provider must bill the full fee schedule amount for the anesthesia charges when using the QK modifier?

Thanks

 

[CodingKing]

I'm not sure if its in writing anywhere but in my training I was told not to reduce and let the payer handle that. Its also how it works at every payer I've worked for. I also don't understand provider groups that bill the contracted amount vs billing full amount and letting is take the contractual adjustment.

*edit*

I did just find a link about reductions and that Medicare will take them in the following document. I also checked the medicare claims manual and i don't see anything advising to reduce on the billing side only that payment will be reduced by Medivcare

https://www.noridianmedicare.com/pr...as_my_allowed_or_paid_amount_been_reduced.pdf