non covered services

Is there a general rule on non-covered services and whether you balance bill the pt or adj off? Specifically, is there any risk for fraud with adjusting off a non covered charge. OR---Does it always go back to the contract language.

Depends...

Did patient sign an ABN if Medicare? Did pt agree to pay if not covered? If commercial insurance then go ahead and write it off- the fraud is if you write off a copay or deductible without attempting to collect.

non covered services

Thank you- to summarize- there is no issue with picking and choosing which payors to write off as long as the denial states non-covered. To further clarify-if it states non-covered and pt responsible you can write off for payors other than Medicare/Medicaid and it is not considered fraudulent such as with co-pays and deductibles?

I'm no lawyer...

but your summary makes perfect sense. Of course the doc has to be willing to give up the income.

non covered services

If you bill them to a third party, you have to watch the denial reasons.

Noncovered (let's say, massage therapy or aroma therapy in the office ) you can bill the patient, and not violate the contract

Bundled or incidental to and the plan is saying it thinks it is paying you for that service as part of another service, like the 99000.

Non Covered Services

Your EOB should tell you if that charge can be billed to the patient or needs to be adjusted off. Some are per contract issues and with that you would need to contact the insurance for clarification of that charge and the application.

non-covered

For a service that is NEVER covered by Medicare (ex, 99172), the patient can be billed. The status of "N" services are found in Addendum B of the Physician Fee Schedule