Author Topic: Non Participating Medicare Providers (Read 3013 times)

msskenny · « **on:** July 16, 2009, 07:51:14 PM »

If a provider does not accept or bill Medicare but a Medicare patient still wants to be seen by the provider and offers to pay out of pocket, can they pay the providers "Private Pay Rate"? Even if it is over the Medicare Limiting charge?

msskenny

PMRNC · « **Reply #1 on:** July 16, 2009, 09:16:14 PM »

Do they have an "opt-out" with Medicare? And some types of providers such as chiropractors cannot opt out.

msskenny · « **Reply #2 on:** July 16, 2009, 09:20:07 PM »

The "Group" and/or providers have not opted out. (not Chiropractors)

msskenny · « **Reply #3 on:** July 21, 2009, 08:26:45 PM »

....can someone help me with my question?.....
If you have a NON PARTICIPATING Medicare Provider/Group that does not accept/bill Medicare, can the provider accept the Group's Private Pay rate (be paid by the patient) as payment in full, and not bill Medicare?
Basically, is it acceptable to collect money from a Medicare member if you do not accept Medicare insurance?

Thank you,

msskenny

PMRNC · « **Reply #4 on:** July 21, 2009, 11:24:56 PM »

If you have not Opted out the answer is no. You have to follow certain procedure to do so. This is a good explanation of "opt out" and how to do it. http://www.aapsonline.org/medicare/optout.htm

Medical Billing Forum · « **Reply #4 on:** July 21, 2009, 11:24:56 PM »

msskenny · « **Reply #5 on:** July 22, 2009, 03:20:42 PM »

Thank you for your help, Linda!

-msskenny

Medical Billing Forum · « **Reply #5 on:** July 22, 2009, 03:20:42 PM »

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