Billing Patients

[Bwilliams29]

Can anyone assist me... Pt signs a waiver at a providers visit. Claim is submitted, and denied as a CO, (contractual obligation) and not a PR, (patient responsibility)... Since a waiver was signed, can you legally bill that patient.... I cannot find any documentation/reference material indicating yes or no.

Thank you for your time.

 

[Paul A]

You should probably check with the payer and see what their policies are. I'm leaning towards you cannot bill the member. If its a general waiver most contracts do not consider that sufficient. It would likely need to be similar to an ABN for Medicare where patient was made aware of the cost of the specific procedure and that its not covered and they they are responsible. What is the actual denial reason, there are many different CO denials.

 

[Jo-Anne Sheehan CPC-I]

Paul A's answer is correct. Check with your payer and the practice's contract with the payer. For example, many patients have payers who require a PCP. If the PCP is not up to date, or a referral is not received - even if the patient signs a waiver stating they will be billed if their claim denies due to them not correcting the problem, the practice can not bill the patient-even with a signed waiver stating they are liable. Many contracts will indicate the problem must be fixed prior to being seen or "reschedule" the appointment. Every contract is different. Some Blue Shield plans will accept a waiver and the denial will indicate the patient cannot be billed unless a waiver is signed. Rules are very specific - just as Medicare has very specific rules with the ABN and the modifiers associated with it.