Wiki Medicare rules for billing patients when non par for part c plans

[mooney2013]

We are a Medicare provider, but are non par for all part C plans. What is the rule about the disallow amount. How much can we bill the patient of a non par Medicare part C patient?

 

[thomas7331]

In most cases, if a non-par provider is aware in advance that the patient is covered under a part C plan, provides services, and bills the claim to the part C plan, then the provider is considered a 'deemed contracting' provider and must accept the terms of the plan and may not balance bill the member beyond the patient share that is listed on the EOB.

Here is a good article on how the requirements work:

https://www.kmcuniversity.com/what-deemed-provider-medicare-replacement-plan