Author Topic: Non Participating with Medicare  (Read 2745 times)

pvtbiller

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Non Participating with Medicare
« on: May 11, 2012, 08:22:25 AM »
Can anyone tell me the difference and benefits of being a non participating supplier with medicare opposed to being participating with them?

Michele

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Re: Non Participating with Medicare
« Reply #1 on: May 13, 2012, 04:05:46 PM »
Both require enrollment.  Non par, payment goes to the patient and the patient must pay the provider.  Benefits:  The provider can get paid at the time the supplies are dispensed and can charge up to the limiting charge which is higher than the allowed amount.  Disadvantage, payment goes to the patient.
Par providers get paid directly and most patients want to go to par providers.  Can only charge the allowed amount by Medicare.
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pvtbiller

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Re: Non Participating with Medicare
« Reply #2 on: May 14, 2012, 10:42:10 AM »
Thank you Michelle.  So, if we have a assignmnet of benefit however - the paymentw would come to us then, right?  We have been recieving paymnet sdirectly as an oon with medicare so I am assuming because I check accept assignmnet this is why?

Michele

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Re: Non Participating with Medicare
« Reply #3 on: May 17, 2012, 10:04:54 AM »
Yes, but then you are also accepting a lower fee than a participating provider, by being oon.
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pvtbiller

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Re: Non Participating with Medicare
« Reply #4 on: May 17, 2012, 11:57:45 AM »
Michelle,

so what is the benefit of being oon if it is less than par?

DMK

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Re: Non Participating with Medicare
« Reply #5 on: May 17, 2012, 12:24:30 PM »
If I'm not mistaken, you can then charge the patient the difference between the allowed amount and your fee.  Medicare pays what they would pay PAR, the patient pays the rest.

Michele

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Re: Non Participating with Medicare
« Reply #6 on: May 19, 2012, 02:47:11 PM »
You can only charge up to the limiting fee though.  Not your fee.  The limiting fee is 10% more than the oon allowed amount so it is only 5% more than the in network.  Personally I don't see why a provider would be oon.  However, that is just my opinion.  I know drs that are oon, I just personally don't get it.  IF I were a provider, (which I am not!!!!) and I were going to be a Medicare provider, I would chose to participate.

Again JMO.
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DMK

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Re: Non Participating with Medicare
« Reply #7 on: May 22, 2012, 11:18:15 AM »
I completely agree!  Medicare can be tough at first, but once you learn their rules, they are the easiest to deal with.  You know what they pay, and what they don't, and you can count on your money like clockwork. (We'll see how long that lasts, but I've been doing this for 12 years and, so far so good!)

This is one insurance that I make sure I KNOW about.  If you can tell the Medicare patients right up front what to expect they will love you.  Screw it up and they tell 20 friends!