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Thread: Medicare

  1. #1

    Default Medicare

    AAPC: Back to School
    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!!!!!!!!!!!!!!!

  2. #2
    Join Date
    Apr 2007


    So no claims were billed from 8/1/08 thru 5/22/09?

    Laura, CPC, CEMC

  3. #3


    Some were and some were put on hold

  4. #4
    Join Date
    Apr 2007


    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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