Medical Billing Forum
Billing => Billing => : rdmoore2003 February 08, 2010, 05:33:48 PM
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Medicare says pt responsibility is 20% of allowed amount.
For 2010 fee schedule, their 20% is not adding up.
(it is the day after superbowl and my mind is frozen)
Please help.
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more info please
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ok here is the situation - 2010 medicare fee schedule- par provider
a new eob is showing:
90804 allowed amount $59.79
paid provider $32.89
pt responsible $26.90
by my calculations, this does not add up to show 20%
please help
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Is is part deductible and part co-pay? It's still early in the year!
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If it's not deductible it may be the Mental Health Deduction - Medicare only pays 50% on most MH dxs.
Michele
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thanks Michele..
So far it looks as if Medicare has dropped to 45% on MH for 2010.
We will see.
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The payment is correct. MH is 55% this year as part of Medicare's Phase out plan for 2010-2014: In 2010 and 2011, Medicare will reimburse for just 55 percent of psychiatric services. Not until 2014 will reimbursement reach the standard 80 percent.
90804 allowed amount $59.79
paid provider $32.89
pt responsible $26.90
59.79 X 55% = 32.89
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thanks so much Michelle.