Self- Pay Patient
Policy: In order to make our services accessible to patients lacking health care coverage, we offer a significant discount for self-pay patients.
We will identify patients *without insurance coverage as Self-Pay and consistently apply a method of billing, discounting, and collecting from the uninsured office patients.
Nephrology Associates offers a flat-rate discount for office patients as well as a percentage option to pay at time of service when the full fee is undetermined. Patients are required to pay at least a portion at time of service and made aware the possible balance that will be billed to them.
Fee Schedule – The simplified fee schedule is based on the Medicare Allowable Fee Schedule and will be updated as needed. It is rounded to the nearest whole dollar. Please make sure you are using the most current fee schedule. A new schedule will be dispersed to office managers for distribution to the appropriate staff as the Medicare Fee Schedule is updated (yearly).
Providers will choose a charge level for new and follow-up visits, and the charge will be manually adjusted by billing when the charge is created. If a patient has paid the maximum estimated level charge and there is a credit, it will remain on the account till the next visit or refunded upon request.
Please continue to flag these patients for billing.
Patients who cannot afford either the self-pay rate or the 20% at time of service will be referred to billing for a payment plan or to CHAP or other resources as needed.
|
BILLING LEVEL 2023 |
CHARGE |
SELF-PAY |
20% COPAY |
BALANCE |
CHAP |
|
|
|
|
|
|
|
|
ESTABLISHED PATIENTS |
|
|
|
|
|
|
Office Outpt Est 10 Min |
99212 |
$ 58.00 |
$ 12.00 |
$ 46.00 |
$ 15.00 |
|
Office Outpt Est 15 Min |
99213 |
$ 93.00 |
$ 17.00 |
$ 76.00 |
|
|
Office Outpt Est 25 Min |
99214 |
$ 131.00 |
$ 26.00 |
$ 105.00 |
|
|
Office Outpt Est 40 Min |
99215 |
$ 185.00 |
$ 37.00 |
$ 148.00 |
|
|
|
|
|
|
|
|
|
NEW PATIENTS |
|
|
|
|
|
|
Office Outpt New 20 Min |
99202 |
$ 75.00 |
$ 15.00 |
$ 60.00 |
$ 30.00 |
|
Office Outpt New 30 Min |
99203 |
$ 115.00 |
$ 23.00 |
$ 92.00 |
|
|
Office Outpt New 45 Min |
99204 |
$ 171.00 |
$ 34.00 |
$ 137.00 |
|
|
Office Outpt New 60 Min |
99205 |
$ 226.00 |
$ 45.00 |
$ 181.00 |
|
|
|
|
|
|
|
|
|
OTHER ITEMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
Nurse Visit/BP Check |
99211 |
$ 24.00 |
$ 5.00 |
$ 19.00 |
$ 15.00 |
|
Urinalysis w/o Micro |
81002 |
$ 10.00 |
$ 2.00 |
$ 8.00 |
$ 10.00 |
|
Urinalysis w/Micro |
81000 |
$ 18.00 |
$ 4.00 |
$ 14.00 |
$ 18.00 |
|
|
|
|
|
|
|
Identifying a Self-Pay Patient: Self-Pay patients will be identified when they make the initial contact with the office.
*A Self-Pay Patient is defined as a patient who:
- Has no health insurance coverage of any kind, including federal and state healthcare programs such as Medicare and Medicaid or other commercial or private insurance coverage from any source.
- Patient does not claim any third party liability for their healthcare treatment.
- Patient is not eligible for worker’s compensation coverage or auto/accident coverage; and has no other responsible party covering the expenses associated with the care received from our office.
NOTE: If a patient claims to have public or private health insurance coverage but is not able to produce verifiable insurance identification, or if the patient has a “high deductible” (HDHP) insurance plan, or if the insurance information provided is for a commercial insurance plan in which our practice does not participate, he or she will not be designated as an eligible Self-Pay patient. The patient can however set up a payment plan with the billing office for the expected expenses.
Educating Self-Pay patients during the pre-appointment phone call:
Provide patients with the payment range information when they make their appointment. Convey that we may not have the entire fee at time of service as this is created by the provider and is unknown to front desk or billing till it is completed. We can estimate based on an established patient what the provider will usually bill, but new patients we cannot assume.
We accept Check/Money Order or Credit Card.
State the expectation of payment at time of visit or alternate arrangements made ahead of appointment and relay this information to the front desk. This could include working with the Billing office for payment arrangements/payment plan. If a patient should over pay, a credit will remain with the patient account or refunded at their request.
Address the cost range with patient on the phone: “The Maximum you could be charged as a new patient is; $226.00” to help mitigate anxiety and set expectations for both Nephrology and the patient.
Immunizations or other injectable drugs for self-pay patients should be avoided, and patient should be referred to a primary care or the local pharmacy/walk-in clinic.
Patients without insurance coverage and in extreme hardship can inquire with the billing office to complete a financial application for further reduction or forgiveness of debt.
Nephrology Self-Pay Routing Ticket
Patient Name: _________________________________________ Date of Service: ___________________ Provider: ____________________________
|
BILLING LEVEL 2022 |
CHARGE |
SELF-PAY |
20% COPAY |
BALANCE |
CHAP |
AMOUNT COLLECTED |
|
|
|
|
|
|
|
|
|
ESTABLISHED PATIENTS |
|
|
|
|
|
|
|
Office Outpt Est 10 Min |
99212 |
$ 58.00 |
$ 12.00 |
$ 46.00 |
$ 15.00 |
|
|
Office Outpt Est 15 Min |
99213 |
$ 93.00 |
$ 17.00 |
$ 76.00 |
|
|
|
Office Outpt Est 25 Min |
99214 |
$ 131.00 |
$ 26.00 |
$ 105.00 |
|
|
|
Office Outpt Est 40 Min |
99215 |
$ 185.00 |
$ 37.00 |
$ 148.00 |
|
|
|
|
|
|
|
|
|
|
|
NEW PATIENTS |
|
|
|
|
|
|
|
Office Outpt New 20 Min |
99202 |
$ 75.00 |
$ 15.00 |
$ 60.00 |
$ 30.00 |
|
|
Office Outpt New 30 Min |
99203 |
$ 115.00 |
$ 23.00 |
$ 92.00 |
|
|
|
Office Outpt New 45 Min |
99204 |
$ 171.00 |
$ 34.00 |
$ 137.00 |
|
|
|
Office Outpt New 60 Min |
99205 |
$ 226.00 |
$ 45.00 |
$ 181.00 |
|
|
|
|
|
|
|
|
|
|
|
OTHER ITEMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Nurse Visit/BP Check |
99211 |
$ 24.00 |
$ 5.00 |
$ 19.00 |
$ 15.00 |
|
|
Urinalysis w/o Micro |
81002 |
$ 10.00 |
$ 2.00 |
$ 8.00 |
$ 10.00 |
|
|
Urinalysis w/Micro |
81000 |
$ 18.00 |
$ 4.00 |
$ 14.00 |
$ 18.00 |
|
|
|
|
|
|
|
|
|
PROVIDER PLEASE INDICATE THE LEVEL BILLED AND RETURN TO FRONT DESK OR BILLING OFFICE. TOTAL COLLECTED: $ _____________________________