Forum - Questions & Answers

May 6th, 2016 - Kworley

Billing consistently

We provide MAC anesthesia as a standard of practice in our ASC. We work hard to make sure each patient has a medical indication that supports providing the MAC. However on occasion a Medicare patient may not have an indication to support that it is medically necessary however the physician's preference is to provide the MAC for the safety or comfort of the patient.

Can we provide Mac in both instances but for Medicare patients with an indication for MAC we bill Medicare and for patients without an indication we just write off the charge and not bill Medicare? All will be provided the same service and all will be charged the same dollar however we would adjust off the MAC charge for the patient with no medical need. Also if I do this for Medicare must I do the same for all payors?

I personally do not like this plan but I do not have any supporting documentation that indicates I cannot do this?

Can you help guide us one way or the other?

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