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Can a Dr Bill a Medicare HMO?

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tomtom2:
Can a doctor that has started the process of enrolling in Medicare bill and see Medicare HMO patients?

Thanks,

Michele:
Do you mean can he bill for seeing patients who have a Medicare Managed Care Plan?  Not patients with straight Medicare?  Participation in the Medicare Managed Care Plans are separate from the straight Medicare.  If he has an application in to become a Medicare provider, that does not automatically enroll him in the Managed Care Plans. 

You need to contact each of the Managed Care Plans that he wants to see patients in and see if he is in network.  American Progressive Today's Options does not require any paperwork for a Dr to be in network.  Just accepting the patients and submitting the claims for payment constitutes as in network.  If he is a BCBS provider, he is probably already in the BCBS Medicare Managed Care Plan, but you need to check.

Each plan has different guidelines.

Michele

tomtom2:
The hospital is in network. The doctor is a hostipal based pathologist. We are not in network with any Medicare Managed Care Plan, but receive payment. My real question is it legal to bill a Medicare Managed Care Plan when you are not officially a Medicare provider?

Michele:
Each Medicare Managed Care Plan has their own guidelines.  Even though they are Medicare plans, they have to follow Medicare rules, their rules for participation depend upon the carrier.  If the carrier allows you to bill and get reimbursed, then it is ok.  You need to check with each individual carrier.

Michele

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