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Q:

If a provider uses two separate fee schedules, one for Medicare and one for the rest of his business, could he be liable for discrimination?

A:

Assuming the Medicare fee schedule is the lower of the two, there is no discrimination from a regulatory standpoint. In fact, you should not charge a Non Medicare patient a fee lower than the fee you accept from Medicare.

From an operational standpoint, we do not recommend the use of two fee schedules unless you are a non-participating provider with Medicare and you are required to bill your limiting charge. (See our response to the Topic, Medicare Reimbursement) Otherwise, the use of a single fee schedule is recommended.

 

Russell Still (bio...)
Executive Vice President

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