NON PAR Physicians and Limiting Charge

Physicians and Limiting Charge

A revolutionary decision was made a decade ago when they decided to implement an electronic health record. Back then, the time and cost to implement the EHR were tremendous but, the results from the EHR altering a patient with a Medicare Advantage Plan sees a physician out-of-network, coverage will be determined by their health plan, and most plans do not have out-of-network coverage.

For the Physicians Billing, regardless of coverage, the maximum that can be charged to a Medicare beneficiary is the Medicare fee. Even if the patient does not have coverage and the physician is not participating in the Medicare Advantage Plan.

This protection also extends to Medicare eligible, but not enrolled patients, who are covered under the Federal Employee Health Benefit Plan or their spouses. The maximum that can be charged to the patient is the Medicare limiting charge.

If the Physician is participating, or non-par, taking or not taking the assignment, the maximum that can be charged is the Medicare fee. The only exception is if the physician has withdrawn from Medicare, and has the patient sign an acknowledgment.

At Medcare MSO we make sure that our clients have true projections of payments and reimbursements. If you have any questions regarding your patient class and community. Call us today at 800-640-6409 and Schedule An Appointment with one of our billing support specialists’ the practice of medicine to help doctors do what they are best at, save lives! The Health Information Technology

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