Billing > Billing

Medicare

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Pay_My_Claims:
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:
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:
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:
And if he does that he has to go by Medicare's limiting charge.

Michele

Pay_My_Claims:
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.

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