Posted in In The Know Series, Insurance, My services, Payers and CPT reinbursement

Does more GHI patients = more revenue? Year 2018

In recent 2 months or so, I have seen an influx of GHI patients coming to my practice.

Great for business, right?….Well it depends on your preference and financial stability of your practice.

Let me Explain.

In the last year In Network Providers have noticed an increase in “Patient Financial Responsibility” and substantial reductions in payments for certain allergy and immunology CPT codes and/or EM codes.

For Example: CPT code like 99213 carries a $30 co-pay and payment of $17 to the provider or no co-pay and a payment of $40 or co-pay of $10 and a payment of $37 to the provider, or co-pay of $30 and a payment of $24 to the provider.

CPT code 94200- carries a $20 co-pay with no payment at all and a co-pay of $22 for CPT code 95117 with no additional payment.

Respectively lower payments compare to other payers.

Providers started to notice this trend and slowly but surely some of them started to either stop accepting new GHI patients or completely stop accepting GHI insurance all together, like ENT.

So should you accept more GHI patients? Well, it is up to you.

I personally created a specific form for GHI patients- informing them of new changes and their new Patient Financial Responsibilities. I let the patients have options to either choose to perform certain services and pay respective co-pay or opt out completely.

Now it is your turn: have you seen an increased amount of GHI patients in your practice? Do you even accept GHI?



My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s