What should practices do if covered and noncovered services are performed for a patient on the same date?

When a practice provides both covered and noncovered services for a patient on the same date, it is critical to follow proper billing procedures to ensure compliance with insurance regulations and to facilitate correct reimbursement. The correct approach is to split the bill for the services rendered.

This method allows for clear delineation between the services that are covered by Medicare or other insurance plans and those that are not. By separating the charges, the practice can submit the appropriate claims to the payer for the covered services while ensuring that the noncovered services are billed directly to the patient. This transparency helps prevent confusion for both the patient and the insurance company, fostering a better understanding of what is covered and what costs the patient will be responsible for.

Combining the charges into one bill can create complications in reimbursement and can violate billing guidelines, as insurers require clear indications of covered versus noncovered services. Charging for the least expensive service only does not reflect the actual services provided and could also lead to compliance issues. Submitting claims separately without any adjustments may not adequately clarify the distinction between covered and noncovered services either, potentially complicating the reimbursement process. Thus, splitting the bill is the most effective and compliant approach.