Advanced Search

General Surgery Coding Alert

Reader Questions:

Don't Let Medicare Set Your Fees

Published on Wed Aug 26, 2009

Question: I have a procedure code that one insurance allows $185.00, yet Medicare allows $26.00. Do I have to charge everyone the same amount, so that in this case I cannot charge the one payer more even though they allow more? Kentucky Subscriber Answer: Medicares fee schedule should not be the guide to your fee schedule. Just because Medicare only pays $26, you do not have to charge every other payer what the government entitlement program is paying. You can charge $185 to the other insurance if your fee for that procedure is $185. In fact, if the fee your practice sets for that procedure is higher than $185, you should charge the higher fee. The payer will then reimburse you based on your contract if you are a participating provider, and based on the insureds contract if you do not participate. --  Technical and coding advice for You Be [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

General Surgery Coding Alert

View All