Question

multiple select question

select all that apply

which of the following are true of patient billing?

most practices have a standard fee schedule that lists usual fees.
whether a code can be billed depends on the payers rules.
the provider should charge more for services for patients with health insurance.
all codes can be billed to the payer.
following billing rules ensures billing compliance.

Explanation:

Analyze standard fee schedules

Using the Practice Financial Policy knowledge point
Medical practices establish a standard fee schedule that lists their usual, customary, and reasonable fees for services. This serves as the baseline for patient billing.

Evaluate payer rules and code billability

Using the Medical Billing Software knowledge point
Whether a specific medical code can be billed to a third-party payer depends entirely on that payer's unique guidelines, coverage policies, and contract rules. Not all codes are universally billable to every payer.

Assess provider charging practices

Using the Practice Financial Policy knowledge point
Providers must maintain a consistent fee schedule and cannot charge higher rates for services simply because a patient has health insurance. Doing so violates compliance and payer contracts.

Examine billing compliance

Using the Coding Compliance Guidelines knowledge point
Adhering strictly to established billing rules, federal regulations, and payer guidelines ensures billing compliance and prevents fraudulent or abusive billing practices.

Answer:

• Most practices have a standard fee schedule that lists usual fees. (Correct answer)
• Whether a code can be billed depends on the payer's rules. (Correct answer)
• The provider should charge more for services for patients with health insurance.
• All codes can be billed to the payer.
• Following billing rules ensures billing compliance. (Correct answer)