Medical Billing Forum
Billing => Billing => : Sophrosyne September 16, 2011, 07:18:47 PM
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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!
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Mental health is not 80% it was 50% and will be raised 5% over the next few years due to parity laws. This year it's 55%
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Wow, that explains a lot.
And such a quick response too! No wonder you're a Hero Moderator! ;D
Thanks and have a great weekend!
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Your welcome :)