Collection of "Office visit co-pay" fees- RESPONSES
Randy McFarland
Description
Collection
Title:
Collection of "Office visit co-pay" fees- RESPONSES
Creator:
Randy McFarland
Date:
4/19/2005
Text:
ORIGINAL POST:
Hi List serve members,
Have you heard of a policy where an office will ask the patient for
an additional cash payment (on top of the fees for services) that is
called something like,
office visit co-pay? Knowing that Medicare considers out of
office visits to be included in the allowable fee, I'm wondering if the
practice of charging an additional fee for in office visits would fly
with Medicare (or MCOs or private insurance companies). Let me know
your opinions and experiences and I'll post to the list anonymously
unless you specify otherwise.
Randy McFarland, CPO
Fullerton, CA
RESPONSES:
I heard from a very reliable source that one particular office of an O&P
mega-company in my state had been charging patients for an office
co-pay.
They cleverly took photocopies of their patient's insurance cards which
told
them how much an office visit co-pay was and then asked the patient for
that
amount. I don't know if they are still doing it, but I wouldn't be too
surprised. I did report it anonymously to my BCBS provider rep. This
was
about 1-1/2 years ago so I don't know if they are still doing this.
Thanks for bringing this subject up, however, because I'm certain it
goes on
in more places than my state. Maybe when all the infighting stops in
our
national groups, we can approach the medical field sounding more
intelligent
and be acknowledged for our professionalism and thereby get paid for our
time.
I attended a Fitting Seminar put on by Freeman recently and discovered
that Physical Therapists are billing Medicare using O&P codes AND also
billing for casting, fitting and deliveries.
I had a woman bring in her daughter
yesterday for bilat custom knee braces. She refused
to give us the daughter's ss# or birthday stating that
it was not necessary since I had a copy of her ins
card. I told her nicely that we did need them for
billing and collections. When she still hesitated, I
simply told her that it would be a cash transaction
and that I'd give her a receipt for the insurance.
She then gave us the info we wanted. I understand
that some insurances are trying to get away from using
ss numbers, but if we have to go after someone for
collections it is much easier with that info. I am
also considering asking for a copy of the driver's
license as well. My ortho docs do that. Any thoughts?
IF YOU ARE A PARTICIPATING PROVIDER YOU CANNOT CHARGE ANYTHING OVER
THEIR FE UNLESS THE PATIENT WANTS TO UPGRADE TO A MORE EXPENSIVE ITEM. I
FOR THE FIRST TIME IN 28 YEARS HAVE GONE NON PARTICIPATING AND CAN PICK
AND CHOOSE WHICH ONES ILL ACCEPT ASSIGNMENT ON AND WHICH I WONT. of
COURSE THE HIGHER PRICE STUFF LIKE PROSTHESES I ACCEPT ASSIGNMENT BUT
SOME OF THE SMALLER THINGS, ESPECIALLY KOS IF THE DOCUMENTATIION FROM
THE DR, ISNT THAT GOOD I MIGHT MAKE THEM PAY. I'm IN REGION C WHICH IS A
NIGHTMARE, ITS TAKING THEM 4 MONTHS TO PAY FOR AN AK PROSTHESES , AND
THEY HAVE BEEN AUDITING KOS FOR CLOSE TO 4 YEARS NOW. IF YOU ARE NON
PARTICIPATING AND NOT ACCEPTING ASSIGNMENT ON A PARTICULAR PATIENT YOU
CAN CHARGE WHAT YOU WANT AND ADD AN OFICE VISIT IN. (I HAVENT CHARGED
FOR AN OFFICE VISIT YET) BUT I CAN IF NOT ACCEPTING ASSIGNMENT. IF YOU
ARE A PARTICIPATING MEDICARE SUPP;LIER AND CHARGE THE PATIENT ANYTHING !
ABOVE THEIR ALLOWABLE IT IS FRAUD AND IT COULD GET YOU INTO TROUBLE. I
WOULD RECOMEND GOING NON PARTICIPATING , THERE ARE NO DRAW BACKS
WHATSOEVER.
I would not recommend this.
While it is true that the office visit is already included in the fee,
out of office visits are not required. Some places do NO home visits at
all because their liability insurance does not cover practitioners while
they were in a patient's home. There is also no REQUIREMENT that we
provide services in a SNF and acute care hospitals, but we routinely do
so anyway. Everybody does because it's good for business. We can charge
any of those entities a flat rate for out of office call if we want
to. I think it would be a mistake because no other O&P providers do
that,
If the billing codes submitted to Medicare are supposed to include
evaluation, measuring, fitting, follow-up, and out of office visits, I
don't see how you can justify an in office visit charge.
If you accept Medicare - you probably can not do it. If you do not you
can charge for whatever you feel is proper for you to remain profitable
and be there when patients need you.
Hi List serve members,
Have you heard of a policy where an office will ask the patient for
an additional cash payment (on top of the fees for services) that is
called something like,
office visit co-pay? Knowing that Medicare considers out of
office visits to be included in the allowable fee, I'm wondering if the
practice of charging an additional fee for in office visits would fly
with Medicare (or MCOs or private insurance companies). Let me know
your opinions and experiences and I'll post to the list anonymously
unless you specify otherwise.
Randy McFarland, CPO
Fullerton, CA
RESPONSES:
I heard from a very reliable source that one particular office of an O&P
mega-company in my state had been charging patients for an office
co-pay.
They cleverly took photocopies of their patient's insurance cards which
told
them how much an office visit co-pay was and then asked the patient for
that
amount. I don't know if they are still doing it, but I wouldn't be too
surprised. I did report it anonymously to my BCBS provider rep. This
was
about 1-1/2 years ago so I don't know if they are still doing this.
Thanks for bringing this subject up, however, because I'm certain it
goes on
in more places than my state. Maybe when all the infighting stops in
our
national groups, we can approach the medical field sounding more
intelligent
and be acknowledged for our professionalism and thereby get paid for our
time.
I attended a Fitting Seminar put on by Freeman recently and discovered
that Physical Therapists are billing Medicare using O&P codes AND also
billing for casting, fitting and deliveries.
I had a woman bring in her daughter
yesterday for bilat custom knee braces. She refused
to give us the daughter's ss# or birthday stating that
it was not necessary since I had a copy of her ins
card. I told her nicely that we did need them for
billing and collections. When she still hesitated, I
simply told her that it would be a cash transaction
and that I'd give her a receipt for the insurance.
She then gave us the info we wanted. I understand
that some insurances are trying to get away from using
ss numbers, but if we have to go after someone for
collections it is much easier with that info. I am
also considering asking for a copy of the driver's
license as well. My ortho docs do that. Any thoughts?
IF YOU ARE A PARTICIPATING PROVIDER YOU CANNOT CHARGE ANYTHING OVER
THEIR FE UNLESS THE PATIENT WANTS TO UPGRADE TO A MORE EXPENSIVE ITEM. I
FOR THE FIRST TIME IN 28 YEARS HAVE GONE NON PARTICIPATING AND CAN PICK
AND CHOOSE WHICH ONES ILL ACCEPT ASSIGNMENT ON AND WHICH I WONT. of
COURSE THE HIGHER PRICE STUFF LIKE PROSTHESES I ACCEPT ASSIGNMENT BUT
SOME OF THE SMALLER THINGS, ESPECIALLY KOS IF THE DOCUMENTATIION FROM
THE DR, ISNT THAT GOOD I MIGHT MAKE THEM PAY. I'm IN REGION C WHICH IS A
NIGHTMARE, ITS TAKING THEM 4 MONTHS TO PAY FOR AN AK PROSTHESES , AND
THEY HAVE BEEN AUDITING KOS FOR CLOSE TO 4 YEARS NOW. IF YOU ARE NON
PARTICIPATING AND NOT ACCEPTING ASSIGNMENT ON A PARTICULAR PATIENT YOU
CAN CHARGE WHAT YOU WANT AND ADD AN OFICE VISIT IN. (I HAVENT CHARGED
FOR AN OFFICE VISIT YET) BUT I CAN IF NOT ACCEPTING ASSIGNMENT. IF YOU
ARE A PARTICIPATING MEDICARE SUPP;LIER AND CHARGE THE PATIENT ANYTHING !
ABOVE THEIR ALLOWABLE IT IS FRAUD AND IT COULD GET YOU INTO TROUBLE. I
WOULD RECOMEND GOING NON PARTICIPATING , THERE ARE NO DRAW BACKS
WHATSOEVER.
I would not recommend this.
While it is true that the office visit is already included in the fee,
out of office visits are not required. Some places do NO home visits at
all because their liability insurance does not cover practitioners while
they were in a patient's home. There is also no REQUIREMENT that we
provide services in a SNF and acute care hospitals, but we routinely do
so anyway. Everybody does because it's good for business. We can charge
any of those entities a flat rate for out of office call if we want
to. I think it would be a mistake because no other O&P providers do
that,
If the billing codes submitted to Medicare are supposed to include
evaluation, measuring, fitting, follow-up, and out of office visits, I
don't see how you can justify an in office visit charge.
If you accept Medicare - you probably can not do it. If you do not you
can charge for whatever you feel is proper for you to remain profitable
and be there when patients need you.
Citation
Randy McFarland, “Collection of "Office visit co-pay" fees- RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/224658.
