Billing > Billing

Medicare

(1/3) > >>

kmoore:
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:
Chiropractors can not Opt Out of Medicare.

Pay_My_Claims:
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 don’t 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:
I concur with that Pay My Claims.  It all about Accepting Assignment.   ;)

Denise 35

Michele:
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

Navigation

[0] Message Index

[#] Next page