Author Topic: Medicare  (Read 1408 times)


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« on: April 10, 2012, 04:35:35 PM »

I do the billing for a psychologist who has just been approved as a participating provider with Medicare. Does she bill her client her usual session rate or does she bill her client Medicare's allowed amount? Then, when billing Medicare, does she bill Medicare her usual session rate or does she bill Medicare their allowed amount? (I wouldn't know the allowed amount until we get an EOB from Medicare, unless I go by the Medicare fee schedule?)

I've read on internet that if your session rate is, let's say, $135, that you bill the client and Medicare $135.  Then they will determine the allowed amount (which will be a lot lower than $135), and pay 80% of their allowed amount, with the client paying the remaining 20%. Then the balance would be written off?

Thank you.


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Re: Medicare
« Reply #1 on: April 11, 2012, 12:19:14 PM »
yes she will bill her rate.  each cpt code should have a set amount that she charges-that rate is billed to insurance


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Re: Medicare
« Reply #2 on: April 12, 2012, 06:43:15 AM »
Yes, and then after Medicare pays you will do the contractual adjustment to disallow any amount over the allowed amount.
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