tci Part B Insider - 2012 Issue 16

Reader Question: Payer Contract Trumps ABN

Question: We dispensed a splint to a patient, but the amount our insurer allows for it is well under the cost to us for that supply. If I bill the insurer I am bound by our contract with them to write off the provider discounted amount in which case our office will lose money. Can I just bypass billing the insurer and offer the patient the option of purchasing without insurance, or is that not allowed since we are contracted with the payer?Iowa SubscriberAnswer: If you are contracted with the insurer, which it sounds like you are, then...

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