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Is it legal to only accept self pay for routine nail care in the private practice setting ?
Regardless of insurance type or coverage, qualifying modifiers, diabetes, laziness, etc, etc....
Reasoning:
No matter how much I discourage routine nail care, I will have endless patients requesting this service.
1. I don't consider this to be worth the time and hassle. It was nice to fill the schedule a few years ago. I don't want to have a team of MA's performing nail care for me either.
2. I find my billing team and office staff spending just as much time chasing down payments from odd ball primary and secondary insurances and Medicare replacement plans in hopes of getting paid a few bucks for this service. They are chasing 45$ instead of 450$.
3. Yeah, I get a few random nail care patients that lead to TNC, MTH excision & other higher paying CPTs. However, majority of those patients I find will locate me directly for those problems as new patients. So, I don't appreciate too much added value in keeping RNC around.
4. I get several patients that "semi" qualify for routine nail care and the ones that don't will argue indefinitely that the previous TFP in California or Kansas or wherever saw them every so many weeks and they never had to pay. Or, "my insurance says I get my nails done 3x per year no matter what" (I absolutely don't like a patient telling me what should or should not be covered).
5. In the recent past I have heard a few stories about pods getting audited by insurance over routine nail codes. I would absolutely have a stroke if I got audited for this reason and had to pay any fines. I would probably submit my CV to Buc-ee's or move to Greenland at that time.
Bottom line: Can I accept cash only or is my only option to punt them to another doctor at initial request ?
Outside example:
I have derm & plastic friends that perform blepharoplasty as self pay only option.
I was told that if you have medical documentation that 30% of vision is obstructed that this is insurance covered procedure.
However, these doctors simply tell even the low vision patients that if they want the service possibly covered by insurance then to go elsewhere.
Regardless of insurance type or coverage, qualifying modifiers, diabetes, laziness, etc, etc....
Reasoning:
No matter how much I discourage routine nail care, I will have endless patients requesting this service.
1. I don't consider this to be worth the time and hassle. It was nice to fill the schedule a few years ago. I don't want to have a team of MA's performing nail care for me either.
2. I find my billing team and office staff spending just as much time chasing down payments from odd ball primary and secondary insurances and Medicare replacement plans in hopes of getting paid a few bucks for this service. They are chasing 45$ instead of 450$.
3. Yeah, I get a few random nail care patients that lead to TNC, MTH excision & other higher paying CPTs. However, majority of those patients I find will locate me directly for those problems as new patients. So, I don't appreciate too much added value in keeping RNC around.
4. I get several patients that "semi" qualify for routine nail care and the ones that don't will argue indefinitely that the previous TFP in California or Kansas or wherever saw them every so many weeks and they never had to pay. Or, "my insurance says I get my nails done 3x per year no matter what" (I absolutely don't like a patient telling me what should or should not be covered).
5. In the recent past I have heard a few stories about pods getting audited by insurance over routine nail codes. I would absolutely have a stroke if I got audited for this reason and had to pay any fines. I would probably submit my CV to Buc-ee's or move to Greenland at that time.
Bottom line: Can I accept cash only or is my only option to punt them to another doctor at initial request ?
Outside example:
I have derm & plastic friends that perform blepharoplasty as self pay only option.
I was told that if you have medical documentation that 30% of vision is obstructed that this is insurance covered procedure.
However, these doctors simply tell even the low vision patients that if they want the service possibly covered by insurance then to go elsewhere.
