# Question????



## ivonneatanacio (Jan 21, 2010)

I have a question and need help.

this is the example:

Patient provider recently opted out of medicare, and the patient needs to have a double masectomy done.

the question is can a non par provider bill for the surgery? or can the patient submitted the claim?

Will the provider receive payment or the patient?

does the provider have to follow medicare guidelines or are they exempt from the guidelines?

can they balance bill the patient for the whole amount not paid???

I know it is many questions, but you input is important....


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## Chanke (Jan 21, 2010)

The patient cannot submit the bill, the provider must always submit for Medicare.  I think he can still do the procedures, but I think the patient may get the payment.  Not sure on that part.


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## Chanke (Jan 21, 2010)

There would be no billing of medicare at all under this circumstance.  It would be payment arrangements between the patient and the provider.  I just doubled checked with my medicare guru on this.


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## ajmtucker (Jan 21, 2010)

It would be considered a self pay surgery


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## LLovett (Jan 21, 2010)

http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

This should have the info you need.

Laura, CPC, CPMA, CEMC


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