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Billing for Allergy Shots

Jamie Posted Wed 03rd of April, 2019 19:04:20 PM
We have a patient that has been getting immunotherapy injections with provider (John Doe) since 2016. Provider (John Doe) is no longer with the clinic, can we still bill the immunotherapy injections under provider (John Doe)?
SuperCoder Answered Thu 04th of April, 2019 03:01:11 AM

Immunotherapy (desensitization, hyposensitization): is the parenteral administration of allergenic extracts as antigens at periodic intervals, usually on an increasing dosage scale to a dosage which is maintained as maintenance therapy. Indications for immunotherapy are determined by appropriate diagnostic procedures coordinated with clinical judgment and knowledge of the natural history of allergic diseases.

If your provider is rendering the services to the patient even he is not the part of your clinic, you can still bill under him, only when he is on your out-network panel; registered with the insurance company to provide the services on your clinic.

In-network provider is one contracted with your health insurance company to provide services to plan members (patients) for specific pre-negotiated charges. On the other hand, out-of-network provider is one not contracted with the health insurance plan. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, the insurance company will either pay less amount or not pay anything for services you receive from out-of-network providers. So, get in touch with your payer (insurance company) and register your doctor onto the out-network panel to reimburse the maximum dollar value. In case the insurance company does not have the out-network services program, then you cannot bill under your provider (John Doe), in that case you have to expand your clinic workforce with new provider.

Hope this helps!

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