Wiki Billing patients cash for procedure covered by Medicare

[michael.compulink]

Is it legal to make Medicare patients pay cash for a procedure that is covered by Medicare just because Medicare's allowance is too low?

 

[sls314]

Is it legal to make Medicare patients pay cash for a procedure that is covered by Medicare just because Medicare's allowance is too low?

If the provider is participating with Medicare, absolutely not.

Non-participating providers can bill up the limiting charge (15% more than Medicare's allowed amount) in addition to deductibles and coinsurance.

Opt-out providers can set their own fees and should communicate that to patients ahead of time. Opt-out providers do not bill Medicare for anything and the patient is responsible for the charges. (Emergency care is an exception.)

 

[amyjph]

Is the provider participating?

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c30.pdf

You can't transfer liability to the patient when Medicare would otherwise pay for items and services.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/abn_booklet_icn006266.pdf

https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare