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Billing question

Brenda Posted Wed 30th of May, 2012 19:52:31 PM

My question is, if a patient has insurance but they asked that we do not bill it, they want to pay for it with cash, can I do that or am I legally bound to bill the insurance that we are contracted with? I know that I have to bill Medicare as we are providers but what about private ins like bc/bs or Aetna?

SuperCoder Answered Thu 31st of May, 2012 10:26:53 AM

For any reimbursable medical service, a provider is actually supposed to bill the carrier, using CMS-1500 or UB-04 form. The claim is a very important tool in this industry. But if you have a specific type/clause in the contract with payer that indicates that for certain services, you need not bill and it will pay you by cash, then you can follow that. But this will be a very rare case. The usual practice is to bill a payer always.

As per contract, there could be some services for which an individual carier might not pay the provider and these informaton would be available in the contract itself.

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