decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 9 (September)
Don't charge parents for after-hours if payers cover the codes
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Article Overview
This piece is for medical practices, coders, and revenue cycle staff monitoring after-hours billing and payer coverage. It discusses how some payers began reimbursing certain office add-on services, why patient billing can create compliance and customer-service issues, and how coverage varies by payer. The article centers on general billing policy, payer behavior, and office workflow considerations for after-hours care.
Why This Topic Matters
After-hours billing can affect reimbursement, patient relations, and payer contract compliance. Understanding whether a payer covers these services helps practices avoid improper patient charges and billing conflicts.
What You Will Learn
- How after-hours office services are being handled by some payers
- Why charging families directly can create compliance and patient-relation problems
- How payer coverage can affect office billing policies for evening, weekend, and closed-office services
- General considerations for managing add-on service reimbursement in a pediatric or family practice setting
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle managers
- Practice administrators
- Pediatric practice staff
Codes Discussed
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