Q for Linda

[Christy]

It's important to know that the Medicare's payment to beneficiaries for unassigned Part B claims is subject to the 2% reduction.

Hi Linda,

THis is from the PMRNC newsletter.

I have a q about this:

Does this mean that the patient pays the additional 2% out of pocket or does the dr have to agree to to a 2% cut when s/he does not accept assignment?

thanks sooo much!

[Dede19]

We cannot bill the patient for the 2% reduction... thank you Sequestration!

"The main issue is this that reduction CANNOT be passed off to the patient and must be adjusted off as a contractual adjustment.

The new code is Claim Adjustment Reason Code 223 “Adjustment code for mandated Federal, State or local law/regulation that is not already covered by another code and is mandated before a new code can be created.”If your system accommodates the write-off based on codes, you need to add this code to your write off structure prior to receipt of the first impacted file."

[PMRNC]

for Part B services provided under assignment (i.e., when the patient agrees to have Medicare pay the physician directly), the reduced Medicare payment would be considered payment in full to the physician (meaning that the physician’s payment receives the 2 percent reduction), but the patient’s cost sharing amount remains unchanged. That is, the physician would continue to collect from the Medicare beneficiary the usual 20 percent co-insurance that applies despite the 2 percent cut.

Example: Dr Service with Medicare allowable of $100, the physician would continue to collect $20 from the beneficiary (20 percent of $100). But during sequestration, the physician’s payment from Medicare will be $80.00 (or 80 percent of $100) minus the 2 percent reduction, resulting in a physician payment of $78.40.

I have not seen the CAR..but I'm not sure if it's because I missed it or not.. thanks for info!!

[Christy]

thanks SO much ladies!

does anyone know if this affects Medicare limiting fees?

I am asking in the case of a chiropractor who performs services denied by Medicare as "maintenance" care. In that case, the DC can bill the patient the Medicare "limiting" fee. Does this get reduced by 2% as well? thanks!

I am thinking no, because the claims I am referring to were assigned?

[Christy]

for Part B services provided under assignment (i.e., when the patient agrees to have Medicare pay the physician directly), the reduced Medicare payment would be considered payment in full to the physician (meaning that the physician’s payment receives the 2 percent reduction), but the patient’s cost sharing amount remains unchanged. That is, the physician would continue to collect from the Medicare beneficiary the usual 20 percent co-insurance that applies despite the 2 percent cut.

so the reduction is for assigned AND unassigned claims?

thanks!

[Christy]

http://www.aan.com/globals/axon/assets/10774.pdf

I think this anwers my questions!

[Dede19]

Yep!  Across the board, par and non-par.