A Consultant Surgeon performs an AB1234 worth £525 together with a DC2468 worth £576.
The patient is insured so an invoice has to be submitted for payment. Therefore you have to calculate the fee payable by the insurance company. Easy. Total is £1,101.
You can’t charge a total of £1,101 i.e. both. You can only charge 100% of the first code’s fee (£525) and 50% of second code’s fee (£576) i.e. £525 plus £288 = £813.00
The problem though is that fee calculation is wrong.
You should charge as follows – 100% of the higher fee and 50% of the lower fee. In the above example, its been calculated the wrong way round.
The correct calculation is to charge £576.00 for the DC2468 plus £262.50 or 50% of the AB1234 fee i.e. £576 plus £262.50 = £838.50.
The potential gain for the consultant is therefore £25.50. Or look at it another way, if you charge it the wrong way round, the consultant will undercharge and loose £25.50
It becomes a bigger issue as most surgeons perform the same procedures many times a month so the same error repeated 10 times costs £255 each month or £3,060 per annum.
How easy is it to make such an error?
Very, very easy.
If the consultant surgeon supplies a theatre list most likely he’ll have the codes written down but it’s a dangerous to assume they are written down in the order they should be invoiced.
You must check them and make sure you are billing codes in the right order if you are to ensure the consultant gets paid the right fee for his work.
If you don’t, you WILL be out of pocket.