Medical Management Associates, Inc.
Ask-A-Consultant: Multiple Fee Schedules for Medicare & Insurance Carriers
I am a non-par doctor with Medicare and most other insurance carriers.
I know for Medicare patients that I must submit all my bills at Medicare's Limiting Charge -
but what about my other carriers.
Can I maintain a regular higher fee schedule for everyone except Medicare and have a second "Medicare" fee schedule?
Palm Desert, CA
Medicare & possible Medicaid in you state has statutory limits on how much you may bill. For Commercial payors you may submit your usual fees. However, if you have signed a contract accepting a plan's usual and customary or a negotiated fee schedule as payment in full, you cannot make the patient responsible for the difference between what you billed and what the plan allows. For example, a patient has an 80/20 contract for a service where you charge $500. If the plan's allowable fee is $300, you may only collect 20% of $300 not $500. If the service is not a benefit of the plan at all, then have the patient sign some form of advanced notice accepting responsibility for your usual change.
Karen M. Beard, CPC
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