Wiki Medicare fee schedule

[melawar]

Are we required to accept Medicare fee schedule from a non Medicare payor, We are Medicare par

 

[thomas7331]

If the patient is Medicare eligible (i.e. in a Medicare Advantage plan), unless you have notified the patient in advance that you are not participating with their plan, you are required to accept the terms of the plan and also accept the fee schedule.

If it is not a Medicare patient, but just a commercial plan that is paying you out of network rates using the Medicare fee schedule, then no, you are not required to accept that fee.

 

[melawar]

Perfect thank you, one caveat .... this program is a tribal plan and they state since they are a federal program and we accept Medicare then we must accept that fee. Does this change your opinion or interpretation at all? We do not believe we should have to accept however I cannot fine any reference or publication to confirm either way