Medical Billing Forum
Billing => Billing => : TMCGEATH June 06, 2014, 11:35:05 AM
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Long story short, one of my providers has been seeing two Medicare Advantage patients and he is not in network with those insurance companies. There are no out of network benefits either. Is he allowed to still ask for some kind of compensation from these patients even though they are technically Medicare patients?
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It depends.. if patient gave you correct information for benefits and provider accepted them, may not be able to.
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This is why before we see any patient we get benefits first. If the patient choses to still be seen and signs correct paperwork that documents this, they are responsible.
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In that situation it sounds like they are a Medicare Provider, took the patient thinking they had traditional Medicare, that's kind of iffy on whether they can collect or not. It's the offices job to make sure they get all info they need to verify benefits and eligibility. If the correct cards were given but the office did NOT verify benefits, I'm thinking they may be able to bill the patient, but I wouldn't count on patient being too happy.
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When a pt has a Medicare Advantage plan, they still have their red, white and blue Medicare card. The patient may have only shown that card. In that case you were not informed of the patient's Medicare HMO and you could bill the patient. Patients can get confused. But if you saw the patient knowing that they were in a Medicare HMO you cannot bill the patient. Always verify benefits.