Partial-Billing Question

[Jess K.]

I recently started working for a new company, who's billing practices are a bit different from what I've worked with in the past. Patients will have an average of 2-3 billable charges/ CPT codes per date of service. They are choosing to bill some codes at the full units/hours, but not others. For example, a billable CPT for 20 units/hours of service with a billable rate of $340 should have been charged but instead they chose to bill for just 8 units/hours at $136 even though the patient was in fact seen for the full 20 units/hours with documentation (and a prior auth.) to justify the charge. I've never heard of this. All the services are fully covered services with a prior authorization yet they continue to under bill. I've continually advised against it but they state that the reason behind this is to maintain a good relationship with the insurer. My argument is that if they continue to underbill, the insurer will eventually recognize this and may discontinue authorizing the full units as they aren't seeing them being utilized in the claims. Also, should a patient have a co-insurance based on billable charges, these will not match patient records. An audit would be a nightmare. Any advice? Links to legal documents I can show the company owners? By the way, we do NOT have a contract with Medicare/ Medicaid- it's all private insurance. Thank you!

 

[Alicia Scott]

This is not my area of expertise but I side with you on this. An audit would be a nightmare AND under billing is just as wrong as over billing. There as some pretty savvy people on the forum and might be able to get you some resources that will help.