Tag: #cptreimbursement

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

Does more GHI patients = more revenue? Year 2018

Posted on by KR2Medical Billing

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?

Posted in Insurance, My services, Payers and CPT reinbursement, Training

Empire Plan(UHC) and CPT code 95004

Posted on by KR2Medical Billing

This is a third installment in my Payers and CPT codes series.

In this installment we will look at the payer Empire Plan (Light Blue card). For this payer UHC is the third party administrator and handles all administrative duties.

Now I am sure you know that when you see a patient with this type of insurance, there is a $20 copay for the office visit. However, not many providers know that there is also another fee for another service, if that services is performed on the same date.

The following will help you to collect the correct amount of patient responsibility from the patient, on the day of services are rendered, and not wait until the claim is processed, which could be 14 or more days; thus increasing your cash flow and reduce your outstanding A/Rs.

In this scenario, you have a new patient coming in to see an allergist for an unspecified allergic reaction:

Code 1: 99204 or 99203 – NEW PATIENT Patient responsibility- $20

Simple.

Ok, now the patient also has not taken any antihistamines in at least the last week and would like to do prick allergy testing , cpt code 2: 95004.

According to UHC, the third party administrator for this plan, 95004- is considered a separate (diagnostice) procedure if performed on the same day, therefore there is also an additional co payment of $20 that is attributed to the patient responsibility.

So, lets review- new patient code 99204 or 99203 w/25 ,a code 95004 for skin testing – patient copay $20 for the office visit and $20 for the prick allergy testing.

Since I already know this in advance, I have a separate form that I give to patients when they arrive to the office, BEFORE performing the procedure.

Giving the patients the option of either doing the prick testing or sending them for blood work (no additional fee when they on that day, if dont in the outside lab)

If you have any other further questions, please feel free to contact me via email or phone, listed on my about me page, or via my LINKEDIN account or my Facebook page.

Until next time!