Author Topic: Medicare  (Read 3375 times)

kmoore

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Medicare
« on: June 19, 2009, 05:50:28 PM »
Hello again
I have a potential new chiropractic client that I will start billing for.  He asked me if he has to file Medicare claims or can he just opt out of filing medicare and have the patient file the claims and get reimbursed for his services?  I wasn't sure on that becuase he is going to be in network with Aetna, UHC, & BCBS
Thanks
Kim

PMRNC

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Re: Medicare
« Reply #1 on: June 19, 2009, 06:00:40 PM »
Chiropractors can not Opt Out of Medicare.
Linda Walker
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Pay_My_Claims

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Re: Medicare
« Reply #2 on: June 19, 2009, 08:45:07 PM »
I think you can opt out, but you have to file the claims.

Misinformation #2: If you are a nonparticipating (nonpar) provider, you do not have to worry about billing Medicare.

Correction: Being nonpar does not mean you donít have to bill Medicare. All Medicare covered services must be billed to Medicare, or the provider could face penalties.

A nonpar provider is actually a provider involved in the Medicare program who has enrolled to be a Medicare provider but chooses to receive payment in a different method and amount than Medicare providers classified as participating. The nonpar provider may receive reimbursement for rendered services directly from their Medicare patients. They submit a bill to Medicare so the beneficiary may be reimbursed for the portion of the charges for which Medicare is responsible.

It is important to note that nonpar providers may choose to accept assignment, therefore, the amount paid by the beneficiary must be reported in Item 29 of the CMS 1500 claim form. This ensures that the beneficiary is reimbursed (if applicable) prior to Medicare sending payment to the provider.

Whether or not a nonpar provider chooses to accept assignment on all claims or on a claim-by-claim basis, their Medicare reimbursement is five percent less than a participating provider, as reflected in the annual Medicare Physician Fee Schedule.

Denise35

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Re: Medicare
« Reply #3 on: June 19, 2009, 11:03:44 PM »
I concur with that Pay My Claims.  It all about Accepting Assignment.   ;)

Denise 35
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Michele

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Re: Medicare
« Reply #4 on: June 20, 2009, 07:27:44 PM »
I think the poster might have meant 'does the provider have to enroll in medicare'.  ??  Maybe??  If he is enrolled in Medicare whether Par or non Par he would be responsible for submitting the claims.

If he chooses not to enroll in Medicare then the patients cannot submit the claims either.

I'm not sure if that's what you meant but in any case I think we've covered everything!  :)

Michele
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Pay_My_Claims

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Re: Medicare
« Reply #5 on: June 20, 2009, 08:17:22 PM »
Linda posted a reply but in the other section. If he means "opt out" She is correct in saying he can't do that, but he can be a non-par provider.

kmoore

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Re: Medicare
« Reply #6 on: June 21, 2009, 09:27:44 AM »
what he was asking me is if he has to take medicare, he doesn't feel it is worth the amount that Medicare pays for claims, so he would prefer to not file medicare claims and just have his patients file their own claims and they are considered a cash patient in his system
Thanks
Kim

Pay_My_Claims

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Re: Medicare
« Reply #7 on: June 21, 2009, 01:52:40 PM »
Well then he will have to be a non-par provider. He can have them pay up front, but he has to bill non-assigned. The Medicare payment will go to the client.

Michele

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Re: Medicare
« Reply #8 on: June 22, 2009, 06:47:18 AM »
And if he does that he has to go by Medicare's limiting charge.

Michele
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Pay_My_Claims

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Re: Medicare
« Reply #9 on: June 22, 2009, 11:29:36 AM »
No, he bills his UCR, but the client will only receive the medicare allowable-minus their coinsurance/deductible

EX: We bill for a k0005 and the client pays up front 2300.00 this is our usual cost. Medicare allows 1941.20 They will pay 1552.96 and the 388.24 would be client coinsurance. So the client receives 1552.96 payable to him. They paid 358.80 more than they would have paid had they went to a par provider. If we had billed assigned, we would have to refund the client the difference since we can't charge over the medicare allowed amount.


PMRNC

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Re: Medicare
« Reply #10 on: June 22, 2009, 01:59:45 PM »
wait.. weren't we talking about Chiro?
Linda Walker
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Pay_My_Claims

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Re: Medicare
« Reply #11 on: June 22, 2009, 07:43:51 PM »
Yes, but uh...I don't know chiro codes!! LOL

Michele

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Re: Medicare
« Reply #12 on: June 22, 2009, 08:04:40 PM »
I'm lost......
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Pay_My_Claims

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Re: Medicare
« Reply #13 on: June 23, 2009, 08:50:49 AM »
This is getting crazy!

PMRNC

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Re: Medicare
« Reply #14 on: June 23, 2009, 12:38:28 PM »
Ha ha.. Meds for everyone!!
Linda Walker
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