Hello all! Very excited to be joining this forum as I am a self-trained biller with few resources other than my own determination!
So I've noticed a strange thing. Medicare has always told us that it pays 80% after the patient's deductible; however, in actuality, it only pays 55% of the Medicare allowed amount. Most of our Medicare patients have a supplimental policy which then pays 45%. But we had one patient with only Medicare and it still paid only 55%.
An actual example: for a 90806, Medicare currently allows $87.42. Of that, Medicare pays us $48.08 (and this is after the patient's deductible has been met). Then the secondary pays $39.34.
I can't help but wonder if I'm doing something terribly wrong...
Any ideas? Thanks a million!
