Hello!
I work in an office alone and I need to bounce this conversation off of other professionals.
Background:
My provider is only contracted with Medicare, Medicaid, and BCBS. All other payers are out of network; however, we do still accept and treat patients under their out of network benefits.
The majority of procedures performed are inpatient and non-elective (neurointerventional diagnostic and treatments - angiograms, thrombolysis, embolizations, etc). We also have an incoming referral base of outpatient and elective inpatient procedures.
The debate:
My provider has the opinion that we should not be subjected to the "multi-procedure discount" because we do not have a contract with the payer. The majority of commercial payers, especially those who follow CMS guidelines, do have a multi-procedure discount policy for non-contracted payers. For the payers that we are contracted with, there is not any argument over the discount.
I have tried explaining that even though the provider does not have a direct contract with the payer, the patient we are treating does. And when we agree to accept a patient with a non-contracted payer, we are agreeing to accept the terms and conditions of that patient's policy. Most non-contracted payers do allow for the balance billing of the multi-procedure discount and the provider has instructed me to bill the patient, not with an expectation that the patient will pay, but rather in hopes that the patient will call their insurance and have the claim reprocessed for full payment.
Note: Per our state laws, I do appeal claims that are processed towards the patient's out of network benefits for emergent procedures and request that the claim be reprocessed at the in-network benefit level. I am successful in most of these; however, the multi-procedure discount is still applied.
My Questions:
1) Can non-contracted providers challenge the multi-procedure discount?
2) Is it an efficient and effective policy to bill the patient so that the patient contacts their insurance payer to request a claim review/reconsideration? Why or why not?
3) What are your office policies on balance billing the patient for the multi-procedure discount when you are non-contracted, for both emergent and elective procedures? Do you notify the patient that they will be responsible for the non-covered service or is it your policy to write-off the non-covered service as an insurance adjustment?
4) Is there an alternative way to approach this subject with my provider?
I appreciate your time in reading this as well as for offering your feedback.
Thank you!
I work in an office alone and I need to bounce this conversation off of other professionals.
Background:
My provider is only contracted with Medicare, Medicaid, and BCBS. All other payers are out of network; however, we do still accept and treat patients under their out of network benefits.
The majority of procedures performed are inpatient and non-elective (neurointerventional diagnostic and treatments - angiograms, thrombolysis, embolizations, etc). We also have an incoming referral base of outpatient and elective inpatient procedures.
The debate:
My provider has the opinion that we should not be subjected to the "multi-procedure discount" because we do not have a contract with the payer. The majority of commercial payers, especially those who follow CMS guidelines, do have a multi-procedure discount policy for non-contracted payers. For the payers that we are contracted with, there is not any argument over the discount.
I have tried explaining that even though the provider does not have a direct contract with the payer, the patient we are treating does. And when we agree to accept a patient with a non-contracted payer, we are agreeing to accept the terms and conditions of that patient's policy. Most non-contracted payers do allow for the balance billing of the multi-procedure discount and the provider has instructed me to bill the patient, not with an expectation that the patient will pay, but rather in hopes that the patient will call their insurance and have the claim reprocessed for full payment.
Note: Per our state laws, I do appeal claims that are processed towards the patient's out of network benefits for emergent procedures and request that the claim be reprocessed at the in-network benefit level. I am successful in most of these; however, the multi-procedure discount is still applied.
My Questions:
1) Can non-contracted providers challenge the multi-procedure discount?
2) Is it an efficient and effective policy to bill the patient so that the patient contacts their insurance payer to request a claim review/reconsideration? Why or why not?
3) What are your office policies on balance billing the patient for the multi-procedure discount when you are non-contracted, for both emergent and elective procedures? Do you notify the patient that they will be responsible for the non-covered service or is it your policy to write-off the non-covered service as an insurance adjustment?
4) Is there an alternative way to approach this subject with my provider?
I appreciate your time in reading this as well as for offering your feedback.
Thank you!
Multi-Procedure Discounts
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