I put his new fee's in writing and had it state, that all clients will be billed the same fee across the board for each CPT code his office bills for. I will be meeting him on Saturday and going to make him sign and date and having it notarized.
"Some practices charge for procedures based on the Medicare-allowable amount, automatically write off the difference between what they normally charge for the procedure and the Medicare allowable, and bill Medicare the allowable. Then, when Medicare pays its 80 percent of the allowable, the practice can easily determine and record in its billing computer system the 20 percent owed by the patient. Practices do this to avoid billing patients more than their 20 percent of the allowable, which is a violation of Medicare law.
Not that I'm arguing the common sense of it... I just don't think it's "illegal". Yes, it may raise red flags, yes, it may get you audited, yes, it may get you in trouble with other insurances, but not "illegal"JMO
I don't think the issue was not billing the patient the 20%, I think it was the amount that actually goes on the claim to Medicare. If a provider puts the Medicare allowable on the claim, Medicare will then pay it's 80% share, leaving 20% patient balance. This whole amount can then be billed to the patient without worrying about whether it's the correct amount or not.... after Medicare pays, the only thing left is the 20%.For example, if a provider charge for 99213 is normally $100. Assume Medicare allows $80.00, pays $64.00 with a $16.00 patient balance. The provider now has to make sure the system is set up to make the medicare adjustment of $20.00 to avoid billing it to the patient
I still stand by my original interpretation. "Practices do this to avoid...."
"Some practices charge for procedures based on the Medicare-allowable amount, automatically write off the difference between what they normally charge for the procedure and the Medicare allowable, and bill Medicare the allowable. Then, when Medicare pays its 80 percent of the allowable, the practice can easily determine and record in its billing computer system the 20 percent owed by the patient. Practices do this to avoid billing patients more than their 20 percent of the allowable, which is a violation of Medicare law.[/u]