As a participating provider with Medicare, am I allowed to bill the patient for non-covered or denied charges at my regular fee, or am I limited to the Medicare Participating Allowance?
As a Medicare participating provider, you have the right to charge your regular office fees for all services to Medicare beneficiaries. If the charges are allowed services, you must then accept the Medicare allowable fee as your payment. However, if the charges are denied, you are entitled to bill your regular office fees for those services (provided they do not exceed the usual amount charged to non-Medicare beneficiaries and you have a signed Advance Beneficiary Notice for CMT). A non-participating physician must adhere to the Medicare Limiting Charge for all covered services (CMT), even if they are denied. All non-covered services (x-ray, therapy modalities, etc.) may be billed at your usual fee.
Related Questions
- I was denied a year ago when I applied for a B-1/B-2 visa through a regular appointment. Am I allowed to apply again with an appointment through my company’s membership in the Business Visa Program?
- When submitting claims for Medicare and/or other insurance deductible and/or coinsurance, are all charges allowed on one claim form?
- Can I charge no-show patients a fee for missed appointments? If yes, can I bill Medicare for a patients missed appointment?
