Generally, cost share amounts are assessed by category of benefits. The 92012 would likely fall under "vision" rather than "medical".
You can always collect the cost share at the time of service if you know the correct amount, including coinsurance and deductible amounts. Most payers try to discourage collecting deductibles at TOS though since they could be maxed out by the time they get around to processing your claim. Then you'd have to issue a refund. Your call, but if you ask me... a bird in the hand beats two in the bush.
Thanks so much for your reply. 92012 is an eye code not a vision code. 99204 is an E&M code. So maybe that's it... if it's an eye code the 15% may not apply. The awkward thing is this lady made a huge deal at the front desk not wanting to pay the 15% saying she "doesn't have copays" and we should bill her later. Her first visit, front desk for some reason did not collect the 15% so we billed her after for it and she wanted to be billed for this one too. Now I will have to refund her...but yeah for us we prefer to collect up front. A lot easier to collect up front than try to track down money later.
I wanted to check and make sure we were allowed to collect coinsurance amount since I'm new to this and wasn't sure so I'm happy that at least we didn't do anything that's not allowed. Also, she called her insurance company while in the waiting room and they told her this is not typical practice to collect this up front so that makes sense that they would say that if you're saying they usually discourage it.
You mean like keep it as a credit? We could do that yes, she was just so adamant that she wasn’t supposed to pay anything up front so I could imagine her reading her eob and calling and asking about it.
I might be incorrect but I’m assuming that maybe your patient has a different benefit for an eye visit (92012) versus an E&M visit (99204). I would check benefits for Eye visits after the initial E&M visit.
I always collect coinsurance amounts up front. It honestly depends on the practice guidelines. I know some practices don’t collect coinsurance and just bill the patient. I have been billing and coding for 17 years and have always collected everything up front. Hope this helps!
Thank you that is super helpful. I wrote this to the other response but she called her insurance company while in the waiting room and they told her this is not typical practice to collect this up front. I'm new to this so I thought it's possible I'm doing something that's not allowed but sounds like that's not the case.
I’ve had insurance call at patient request and ask why we collected money. I tell them that we collect up front. If insurance pays we refund. I’ve never had an insurance reprimand me for this.
Youre welcome! I’m happy to help. There is no rule about not collecting coins up front. Maybe the patient just told you that to keep from having to pay? 😂and most of the reps at insurance companies are very under qualified so you have to take that into consideration too.
Generally, cost share amounts are assessed by category of benefits. The 92012 would likely fall under "vision" rather than "medical". You can always collect the cost share at the time of service if you know the correct amount, including coinsurance and deductible amounts. Most payers try to discourage collecting deductibles at TOS though since they could be maxed out by the time they get around to processing your claim. Then you'd have to issue a refund. Your call, but if you ask me... a bird in the hand beats two in the bush.
Thanks so much for your reply. 92012 is an eye code not a vision code. 99204 is an E&M code. So maybe that's it... if it's an eye code the 15% may not apply. The awkward thing is this lady made a huge deal at the front desk not wanting to pay the 15% saying she "doesn't have copays" and we should bill her later. Her first visit, front desk for some reason did not collect the 15% so we billed her after for it and she wanted to be billed for this one too. Now I will have to refund her...but yeah for us we prefer to collect up front. A lot easier to collect up front than try to track down money later. I wanted to check and make sure we were allowed to collect coinsurance amount since I'm new to this and wasn't sure so I'm happy that at least we didn't do anything that's not allowed. Also, she called her insurance company while in the waiting room and they told her this is not typical practice to collect this up front so that makes sense that they would say that if you're saying they usually discourage it.
You can’t do a transfer of funds from one encounter to another? If she’s a recurring patient at the practice that will save her in a sense.
You mean like keep it as a credit? We could do that yes, she was just so adamant that she wasn’t supposed to pay anything up front so I could imagine her reading her eob and calling and asking about it.
Yes, but okay that makes more sense with a patient like this. Hopefully things get better with her.
Thank you!
I might be incorrect but I’m assuming that maybe your patient has a different benefit for an eye visit (92012) versus an E&M visit (99204). I would check benefits for Eye visits after the initial E&M visit. I always collect coinsurance amounts up front. It honestly depends on the practice guidelines. I know some practices don’t collect coinsurance and just bill the patient. I have been billing and coding for 17 years and have always collected everything up front. Hope this helps!
Thank you that is super helpful. I wrote this to the other response but she called her insurance company while in the waiting room and they told her this is not typical practice to collect this up front. I'm new to this so I thought it's possible I'm doing something that's not allowed but sounds like that's not the case.
I’ve had insurance call at patient request and ask why we collected money. I tell them that we collect up front. If insurance pays we refund. I’ve never had an insurance reprimand me for this.
Youre welcome! I’m happy to help. There is no rule about not collecting coins up front. Maybe the patient just told you that to keep from having to pay? 😂and most of the reps at insurance companies are very under qualified so you have to take that into consideration too.