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Medicare question

  1. Default Medicare question
    Medical Coding Books
    This isn't necessarily a coding question but I'm doing some research and I want to see if I can track something down. For years, I was told or understood that if you saw a patient that was in a federally funded plan and you were a participant in any federally funded plan - i.e. Medicare - you could not charge the Medicare patient more than what you would have charged a private pay patient. In other words, you couldn't have two fee schedules - one for Medicare patient's and one for private pay patient's that was below the Medicare par amount. The problem is I cannot find this anywhere on the internet in the Federal register. Can someone help me out? And is this correct?

    I know there is some leeway so to speak from organization to organization in regards to how to handle indigent or private pay patients and also rules regarding establishing indigency. With the economy the way it is, we are going to be seeing more and more private pay or underinsured patient's and I want to make sure we are handling things appropriately.

    Also - does anyone know if this rule might be different for "Doc in a box" clinics so to speak?


    Janet Gryder

  2. #2
    Default FQHC Billing
    I am horrible at finding the information I need in the manual (on-line). However, I have billed for FQHC facility for 7 years now. I have attended numerous webinars and educational opportunities for FQHC billing. You are correct that your charge amount for a patient account for Medicare 99213 can not be more or less than that of a commercial client for a selfpay client, Medicaid or indigent client. An FQHC should 'charge' everyone the same.

    Now, we may charge $80 for an 99213, however, we bill Medicaid our rate and they pay the rate... For Medicare, we bill Medicare our $80 charge and they apply our rate and pay with the coins for the pt equaling $16 (20% of the charge).

    I have created a national FQHC billing email list serv where each of us as members can send out an email to the entire group to get responses from within the group. Many of the ladies in the group are CFOs and billers for FQHC centers. We are a great resource to each other. Please email me at with permission to share your email address with the group. I will then email you the list of those currently in group. Then you can submit the question you have submitted here to the list serv.

    I hope this helps.

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