A crown is prepped, delivered, and reimbursed by the payer. The crown fails shortly thereafter, the tooth is extracted and the patient needs a bridge. The doctor wants to offer a treatment credit to the patient for the failed crown. How should this be handled?

Answer

The fee submitted for the new bridge should reflect the discount (treatment credit) given to the patient. The fee reported should be the fee the doctor intends to accept as payment in full. All discounts must be deducted from the full practice fee, and the discounted fee reported on the claim form. It would be improper to give a discount toward the patient’s copay and not submit the actual fee the doctor intends to accept as payment in full for the service provided. 

For example: The original crown fee was $1,000, and the patient paid $500. The doctor gives the patient a credit of $500 towards the new bridge. The full bridge fee is $2,800, but the fee reported on the claim form is $2,300, not $2,800, since the patient received a discount of $500.