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After Hours Visits Earn Additional Income Make Sure You’re Billing Accordingly

Friday, August 18, 2017

After Hours Visits Earn Additional Income
Make Sure You’re Billing Accordingly


Providers who treat patients after office hours, on holidays and on weekends may be eligible for additional reimbursement. What do payers consider after hours? How much additional revenue can billing extra for after-hours visits generate? WCH can help determine what codes to use, and when, to recover missed income.

Generally, individual providers who treat patients for an urgent illness or condition between 5 p.m. and 8 a.m. on a weekday, or any time during a weekend or holiday, are eligible for additional reimbursement when using an after hours CPT (current procedural terminology) code.

While the exact definition of “after hours” varies by insurer, most reimburse for services rendered outside of regularly posted office hours. This does not include patients who had appointments during office hours, waited, and were seen later because of delays.


Determining Eligibility


“WCH billers often find legitimate reimbursement situations when clients communicate with us regularly,” says WCH Billing Department Supervisor Elvira Kasimova. “We know what payers are looking for, and which ones will reimburse in each circumstance. The better we know our providers the more we can help determine which add-on codes apply.”

A few considerations:

  • Reimbursement varies according to specialty. Most payers honor after hours CPT codes for family and internal medicine practitioners.
  • Some payers also honor after hours codes for providers who regularly see patients on Saturdays. WCH helped one family practice with regular Saturday hours receive $10-$20 extra per patient, which generated an additional $100-$150 weekly.
  • Urgent care centers, where doctors regularly treat patients after hours and on weekends, usually don’t qualify.

“When providers accommodate patients by offering after hours appointments, they should be compensated for their time,” says Elvira. “We can help.”





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