Medicare Reimbursement

[janetsullivan]

Hello,

Provider bills CPT code 42815 (Status Indicator J1) TOB 131, line item billed charges $5285.00. Medicare allowed is $6311.06. Does Medicare reimburse the provider (hospital) greater than billed charges (the Medicare allowed)?

 

[ahrx13]

Most contracts I've seen will only reimburse for whatever is lower between the billed charges or the insurance allowed amount. If you are finding that your billed charges are below Medicare allowable amount (or any other insurance allowed amount), you may want to raise your charges.