1) When a Medicare payer reduces an ASC claim by using MPPR, is the ASC allowed to balance bill the patient the difference?
2) When a commercial payer reduces an ASC claim by using MPPR for a non-contracted provider, is the ASC allowed to balance bill the patient the difference?
3) Are MPPR rates typically 100-50? I have ASC claims reduced using MPPR at rates of 100-25-10, then the non-contracted commercial payer sent EOB's to the patients and payer representing that the patient is not responsible for the difference between the reduced amounts and the provider's billed charges and the provider cannot balance bill. I was informed by the non-contracted commercial payer that they consider any balance billing after MPPR to be unjust enrichment by the provider, so they do this.Any comments would be appreciated.Thanks,
Provider is non-participating with commercial insurance and patient is billed full balance. Patient has received an EOB showing ONLY co-insurance or deductible as PR and a code/note that $XX is non-allowed. The EOB does NOT show the patient is responsible for this as well. 17
When filing the claim, are you "accepting assignment of benefits"? This can cause an issue with an out of network plan.