Payments > Insurance Payments

Non Participating with Medicare

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pvtbiller:
Can anyone tell me the difference and benefits of being a non participating supplier with medicare opposed to being participating with them?

Michele:
Both require enrollment.  Non par, payment goes to the patient and the patient must pay the provider.  Benefits:  The provider can get paid at the time the supplies are dispensed and can charge up to the limiting charge which is higher than the allowed amount.  Disadvantage, payment goes to the patient.
Par providers get paid directly and most patients want to go to par providers.  Can only charge the allowed amount by Medicare.

pvtbiller:
Thank you Michelle.  So, if we have a assignmnet of benefit however - the paymentw would come to us then, right?  We have been recieving paymnet sdirectly as an oon with medicare so I am assuming because I check accept assignmnet this is why?

Michele:
Yes, but then you are also accepting a lower fee than a participating provider, by being oon.

pvtbiller:
Michelle,

so what is the benefit of being oon if it is less than par?

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