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Wiki Medicare

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sblanchard

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Houma, LA
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I have a dr. Who has been with us since 08/01/2008 but the old office manager never sent in paper work to link to our group. When i became manager i did paper work and his effective date is 05/22/2009. My question is can i balance bill the patient the 20% of the allowed amount to the pt who had services before the dr. Effective date.


Thank you!!!!!!!!!!!!!!!
 
How were they billed and what was Medicares response?

I'm not really sure in your situation but I don't think you would be limited to only collecting 20%. Non-participating providers are subject to a limiting fee but other than that they can collect everything between what medicare paid and the limit.

I have never dealt with this from the stand point of a participating office with a non-credentialed provider. I have worked for providers that are in private practice and are non-participating. We collected our full fee (it was less than the limiting fee), mailed in a claim form and medicare paid the patient.

Laura, CPC, CEMC
 
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