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mstyus

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Hi, I have a scenario just say a physician charges 750 for a procedure and medicare only pays 150 can the patient be held accountable to pay the difference if not where do the physician get the funds from or is it just lost revenue? If anyone have knowledge of where I can get documentation I will greatly appreciate it.
Thanks in advance,
Ms.Tyus
 
The difference is what is called "Contractual Adjustments". In other words, you can NOT collect this from the pt. Medicare has a fee schedule that shows what they will allow for procedures that are covered under Medicare. They (Medicare) will only pay 80% and the pt is responsible for the other 20%. Keep in mind that it is 80/20 of the allowable, not the billed amount. This is of course assuming that your Dr is credentialed with Medicare. You can go to http://www.trailblazerhealth.com/ and search the Fee Schedule for the allowables and also on how, what, and who can bill Medicare. Not sure what State you are in so make sure that this site covers your State.
 
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