What fee should be reported on the claim form, the full practice fee or the PPO fee?

Answer

Always submit your full practice fee on the claim form. Submitting your full practice fee on the claim allows for the following:

• Proper calculation of patient benefits for COB by the secondary payer.
• Payers review submitted fees to help determine fee schedule increases. Not submitting the full practice fees may result in missing out on this increase.
• The practice can track write-offs for each PPO plan. 
• The practice will receive the benefit of any fee increases.