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Thread: Required to Bill Medicare - Mental Health

  1. #1
    Join Date
    Apr 2007

    Default Required to Bill Medicare - Mental Health

    AAPC: Back to School
    I have a clinic that is not contracted with Medicare because they do not have PHD level therapist on staff so we are not even able to set them up to send claims to Medicare. They only have LMFT’s on staff. So how does that work?

    Are we required by law to bill Medicare (even though we know they will reject it)?
    Should/Can we submit to Medicare with the GA (and ABN of course)?

    Is it required by Law that we have to send claims to Medicare?” Even if the provider is not contracted and cannot be.

  2. #2

    Smile Billing to Medicare


    Well .. you have several options, here.

    1) You can refer them to another office, that is Medicare certified;
    2) You can charge your Medicare patients cash (explaining that your office is not for Medicare patients); or,
    3) You can negotiate with them a price that is ok with everyone.

    To simply bill Medicare, so they can deny you (because the office is not authorized by Medicare), will only allow you to balance-bill the patients. I don't know if you can balance-bill Medicare patients for anything. According to Medicare Patient rules, you collect the patient's co-pay, bill Medicare, receive Medicare's payment / EOB ... and write-off the balance Medicare didn't pay.

    Hope that helps ...


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