AboutMerry Schiff Expertise I am very familar with Medicare and general insurance questions. I can answer general questions about HMO's.
Experience I have been in the medical billing industry for 50 years. I have helped develop software for this industry. I am a consultant to billers and the medical profession.
Organizations I am the Executive Director of NEBA, a medical billing organization with nearly 1000 members.
Education/Credentials I have been teaching medical billing for many years as well as being a published author with Pearson Education. One book on medical billing (nearly 800 pages) and one on HIPAA.
Question QUESTION: My son is a Medicare patient of a psychologist who has not agreed to become a Medicare provider.
He has paid her the full fee. He would like to submit the bill directly to Medicare for partial payment.
What information does the provider need to provide to medicare.
How a physician submit patients' bills to Medicare? Where do I find this information on the site?
Thanks You,
David
ANSWER: If the psychologist has opted out of Medicare, she must inform the patient that for two years, neither she nor the patient can bill Medicare. I would call Medicare to see if she actually signed a contract that she opted out of the program. Then, get back to me. If the provider just does not accept assignment for Medicare, the provider still must bill Medicare, NOT YOU. Let me know the situation. The question to ask Medicare:
1. Has the psychologist opted out of Medicare (she must have a signed affidavit with Medicare)
2. Or is the psychologist not accepting assignment (she still must bill and the patient is only responsible for a certain amount of the fee. Medicare puts a limiting chargeon the service.
Merry
---------- FOLLOW-UP ----------
QUESTION: Thanks Merry - this information is very helpful. She has not accepted assignment for Medicare. If she is to bill Medicare for my son's services - are there directions available for this process?
Thanks again for your help.
David
Answer David..She had better know how to do it. It is a Federal law that she must submit the claim. And she can only charge the limiting charge. To find out what that is, you will need the CPT code that she is using. Do not pay her full price. Medicare will send your son a check but SHE must file the claim. And be sure that she does. Tell her that you want a copy of it. Then you have it for your records. Let me know if you need any more help.
“Non-participating Providers” do in fact participate with Medicare. Non-par providers generally do not accept assignment on a regular basis; however, can choose to accept assignment on a case-by-case basis and be reimbursed at the non-par level. Non-par providers must also bill Medicare, but Medicare reimburses the patient versus the provider. The amount patients receive from Medicare will be 5% less than the par-allowed amount and the patient pays the provider for services rendered.
A non-par provider can legitimately increase reimbursement by charging the “limiting fees”, which represent the maximum allowable reimbursement. Limiting fees, as well as, par and non-par allowed fees can vary by region, state, and even city and can be found at www.cms.gov.
