tci Medicare Compliance & Reimbursement - 2013 Issue 14

Reader Question: Avoid Skirting the System to Save Patients Money

Question: We have a patient who wants us to directly bill her allowable charges for a procedure so that she can pay our office this amount instead of paying her deductible since she has a very high deductible. Is this legal? Answer: If your provider has a contract with the insurance company, you must submit the claim to the payer and then collect from the patient only the amount indicated by the explanation of benefits (EOB). Pitfall: If you do not submit the claim, there is nothing to prevent the patient from submitting the claim and being reimbursed, and...

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