billing

AS A PREFERRED PROVIDER WHEN BILLING FOR A PROCEDURE AND PAYMENT IS RECEIVED, ARE YOU ABLE TO BILL A PATIENT FOR THE DIFFERENCE OF A BALANCE IF CERTAIN SERVICES ARE NOT COVERED?

(ie PROCEDURE ITSELF COVERED HOWEVER SURGICAL TRAY, LOCAL ANESTHESIA, NOT COVERED -- CAN YOU STILL BILL THE PATIENT DIRECTLY FOR THE SURGICAL TRAY AND ANESTHESIA?)

bundled

not usually. if you look at CPT guidlines for global surgery package i believe it is all bundled

billing for services during a procedure

CPT guidelines (as well as NCCI) consider the local anesthestic as part of the global payment to the physician/surgeon.

Since the inception of RBRVS, payment for supplies has been included in the payment for CPT codes. Having said that, clients tell me that some few commercial payers continue to pay for the surgical tray.

The issue with companies with which you participate is this: Do they deny the service as "bundled into payment for another service" or "incidental to another service?" If they use those words, then per their agreement with you, they consider it part of the payment for the surgical service.

If they deny it as "non-covered" than you can bill the patient. Think of this example: If you decided to hire a massage therapist in your office, those services would be non-covered and you could bill the patient.

Most of the things we want to bill the patient for (lie 99000) are not denied as non-covered but as bundled, which prohibits us from billing the patient.