Patient Notification for Self-Payer Payment Policies for Certain In-Office Procedures
The AAO-HNS has drafted a template letter that members may use to notify patients of additional payments for certain diagnostic procedures performed during office visits for which they may be financially responsible. This letter is generic and acts only as guidance for you to construct your notification; you should edit the list of procedures to reflect the specific procedures you performed on your patient on the stated date of service. Use your company letterhead/logo as well as fill in the blanks. To view the letter, go to http://www.entnet.org/Practice/Appeal-Template-letters.cfm. Contact the Health policy department at Healthpolicy@entnet.org if you have any questions on this letter. Company Logo [centered] [the rest align left] Patient Name: ___________________________________ Please be aware that certain procedures performed in our office are not included in the standard office visit. These procedures will be billed separately and in addition to office visit charges. We have become aware that some insurance carriers are classifying these procedures as “Surgery” and applying the charges to a higher deductible amount. The result may be insurance payment for an office visit but not a procedure. In such cases, payment for the procedure will be due from the patient. Be assured that we are following accepted billing and coding guidelines and that all procedures are performed in the best interest of patient care. Examples of in-office procedures include: – Flexible laryngoscopy: This procedure involves passing a long thin flexible fiberoptic scope through the nasal cavity and into the throat. The fiber-optic scope enables the physician to visualize areas of the throat not readily seen using the laryngeal mirrors. – Nasal endoscopy: This procedure uses the flexible or rigid scope attached to a light source to view areas of the nasal cavities that cannot be viewed by the physician using the standard nasal speculum and head mirror. – Nasal endoscopy with debridement or biopsy: This is the same procedure as above with removal of crusting or tissue. Please speak with our nurse or clinical assistant if you have any questions. ___________________________ _________________ Patient Signature Date
The AAO-HNS has drafted a template letter that members may use to notify patients of additional payments for certain diagnostic procedures performed during office visits for which they may be financially responsible. This letter is generic and acts only as guidance for you to construct your notification; you should edit the list of procedures to reflect the specific procedures you performed on your patient on the stated date of service.
Use your company letterhead/logo as well as fill in the blanks. To view the letter, go to http://www.entnet.org/Practice/Appeal-Template-letters.cfm. Contact the Health policy department at Healthpolicy@entnet.org if you have any questions on this letter.
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Patient Name: ___________________________________
Please be aware that certain procedures performed in our office are not included in the standard office visit. These procedures will be billed separately and in addition to office visit charges. We have become aware that some insurance carriers are classifying these procedures as “Surgery” and applying the charges to a higher deductible amount. The result may be insurance payment for an office visit but not a procedure. In such cases, payment for the procedure will be due from the patient. Be assured that we are following accepted billing and coding guidelines and that all procedures are performed in the best interest of patient care.
Examples of in-office procedures include:
– Flexible laryngoscopy: This procedure involves passing a long thin flexible fiberoptic scope through the nasal cavity and into the throat. The fiber-optic scope enables the physician to visualize areas of the throat not readily seen using the laryngeal mirrors.
– Nasal endoscopy: This procedure uses the flexible or rigid scope attached to a light source to view areas of the nasal cavities that cannot be viewed by the physician using the standard nasal speculum and head mirror.
– Nasal endoscopy with debridement or biopsy: This is the same procedure as above with removal of crusting or tissue.
Please speak with our nurse or clinical assistant if you have any questions.
___________________________ _________________
Patient Signature Date