Medicare

[PMBS]

Does anyone know what we can legally bill Medicare?  I was told that the physican could bill 150-200% of the Medicare fee schedule. 

For example we are a participating provider who bill $120.00 for a 99214.  We know that Medicare only allows 91.24 and that is what the physican will be paid.  The patient was upset because we billed Medicare $120.00 and now the physican thinks that he has to bill at Medicare's fee schedule. 

Do we have to bill at Medicare's fee schedule and if not where could I find information showing otherwise so I could show the doctor.

Thanks
MR

 

[Pay_My_Claims]

I'm not 100% sure of the range, to my memory it is something close to that. As far as the client goes. did you tell them that they are only responsible for their 20% after Medicare, and no matter what the physician fee is, Medicare will pay the same rate? Let the Physician know he does not have to bill Medicare just their charges otherwise he will lose money since private carriers reimbursement is different and he can't bill Medicare differently than others.

[PMBS]

Yes, I tried explaining this to the doctors son and now they are all freaked out about it.  Before I took over his billing he was billing at Medicare rates and losing money because they never updated the fee schedule.  Do you know where I can go online and find info stating that it is ok for the doctor to bill that much?

Thanks for responding

[Pay_My_Claims]

Not sure where you are located, but I am in Jurisdiction C and our FI is Cigna Government Services.
You should be able to access your FI and get the same information.

http://www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf

If I can find something clearer I will let you know. I am registered with MDTools and that gives you a clear breakdown of the UCR in your area and helps your provider determine if his fees are too high or low for his area

[Pay_My_Claims]

You can let him see this link also

http://www.cms.hhs.gov/PhysicianFeeSched/

Good blessings

[Michele]

Thanks for the great info Charlene. 

Just one more thing.  It's not what you bill Medicare - it's what you charge the patient.  As long as you never charge the patient over what Medicare allows and clearly spells out on the EOB as pt responsibility, you are not doing anything wrong. 

But I have dealt with providers who seem to get freaked out over Medicare so I truly sympathize with you. 

Good luck.

Michele

[PMBS]

Thanks guys.  Trust me I went over all this with the doctor and his son and they think they are going to get in trouble. The patient was billed what the Medicare EOB said we could bill them.

Thanks again.