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Medicare Charges

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dfranklin:
Does Medicare limit on what we can charge? I know they have limits on what we can pay but is there a limit on what we can charge or do we just charge what ever fees the provider feels is standard to all insurances and medicare reduces as necessary?  My provider thinks we can't charge over a certain limit to medicare....

Thanks!

Don

PMRNC:
Yes, it's called the "Limiting Charge" It is on the EOB, doctors can charge 15% above allowable.

dfranklin:
So then you have to have 2 sets of fees loaded into your software. 1 for Medicare where it is only 15% above allowable and the other set for all other carriers? 

What happens if you charge above the limiting charge or 15%?

Pay_My_Claims:
HUH?? You only have 1 fee schedule

Michele:
I'm assuming this is a non par medicare provider.  You can bill your regular fees to Medicare but you can only charge the patient what Medicare says you can.  If it is a non par provider, they can charge the patient up to the limiting fee.

Michele

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