Fee Schedule Notice Template | MDO103-2

Fee Schedule Notice Template

The Fee Schedule Notice Template covers medical office visits, immunizations/injections, supplies, and more. Once the doctor has finished examining the patient, the patient will then proceed back to the reception area for checkout procedures. The doctor will bring the patient’s chart up to the front desk, along with the procedure sheet, appropriately filled-out. This sheet will contain the codes that the doctor used to diagnose the patients (ICD-9 Code), as well as the codes used to charge the patient for the visit (CPT Code). MDO103-2 FEE SCHEDULE can be used for a sample Medical Office fee schedule.

If the patient is paying for the visit privately, the receptionist will take the payment from the patient and give them a receipt for the visit, along with a copy of the procedure sheet. The patient may then submit the appropriate forms to their insurance company if they participate with a plan not accepted by the medical office. If the patient participates with an medical insurance policy that is accepted by the medical office, they may be required to pay a pre-set co-payment. The receptionist will take the co-pay from the patient and submit the rest of the bill to the insurance company for reimbursement. The patient will receive a copy of the procedure sheet, if needed.

Fee Schedule Notice Template Details

Pages: 02
Words: 357
Format: Microsoft Word 2013 (.docx)
Language: English
Manual: Medical Office
Procedure: Billing Procedure MDO103
Type: Guide

Related Documents

• MDO103-1 PAYMENT POLICY