Medical Billing Forum

Payments => Insurance Payments => Topic started by: Alice Scott on March 02, 2008, 05:09:03 AM

Title: Billing Medicare Out of network
Post by: Alice Scott on March 02, 2008, 05:09:03 AM
Question
Hi,

I am so glad that a colleague E=ed me your site. whew.

OK...I am a licensed social worker with a doctorate. I have been in private practice for over 20years. Some of my patients have medicare.  I am under the impression that if I accept medicare I am tied into accepting their paltry reimbursement. Don't even know the fee for service...but I guess that it is far short of my fee.

My question is: can I bill medicare as some kind of "out of network" provider? And if so, how do I go about it?

I have struggled and given up on using their web site or phone...as it is a maze in which I get lost.
Thank you, in advance, for you help. 
Dr. Dee U

Answer
Dr. Dee
    The only way to bill Medicare is to obtain a Medicare provider number.  That is done by completing the CMS 855I form.  You can choose to be a non participating Medicare provider, which means that you do not have to accept the Medicare allowed amount, but you do have to accept the limiting charge, which is slightly higher.  And the patient will be paid directly, you will have to bill them.  However, in order to bill them you do need to get a Medicare provider number.

Michele