Medical Billing Forum

Payments => Insurance Payments => Topic started by: Lucy100 on September 26, 2012, 03:22:29 PM

Title: what to do when medicare doesn't cover it
Post by: Lucy100 on September 26, 2012, 03:22:29 PM
Hi - another question!  :) 

This is a speech pathology practice.  As is probably well known, Medicare doesn't want to cover everything we do.

We are thinking of going non-participating. 

My question is, what if we have a medicare patient and they need services that Medicare A) doesn't cover at all, or B) only covers part of.  I guess I'm confused about the process in this situation.  I imagine speech therapy goes thru this a lot?  (Speech language pathology to be specific)
Title: Re: what to do when medicare doesn't cover it
Post by: Lucy100 on September 26, 2012, 03:23:27 PM
im also trying to figure out if there's any reason we don't just go participating... i mean, i don't see the advantages of being non-participating... anyone enlighten me?
Title: Re: what to do when medicare doesn't cover it
Post by: PMRNC on September 26, 2012, 06:57:16 PM
You sort of have two sets of questions.

The services are non covered why? Because they are non covered services in general.. specifics might be a bit more helpful. For general non covered services a par or non par medicare provider would bill with an ABN which the Medicare Beneficiary signs that basically says they know Medicare won't pay so they agree to pay.

Now if these services are just plain NOT covered, you might not benefit at all by participating as your still going to seek payment from patient.