Advanced Search

Medicare Compliance & Reimbursement

Reader Question:

How Should You Bill Medicare?

Published on Tue May 15, 2012

Question: We are participating with Medicare. We bill and submit claims to Trailblazer (J4 MAC). When payment arrives, we post the allowable and contractually adjust off the remaining portion and/or apply the appropriate amount to the patient deductible per the CMS remit. However, my predecessor was billing only the Medicare allowable for each code? Am I doing it right? Or was she? Answer: Both methods are technically correct. Practices bill Medicare in two different ways: 1. Some practices bill Medicare at the Medicare fee schedule. That sounds like how your predecessor was doing things, by billing the Medicare allowable. When you bill this way, you just have to bill the patient the copay and deductible if it applies. 2. The other way to bill Medicare when you participate is to bill the MAC at the full fee schedule for the practice. Then, you have to do what you explain in [...]
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 Revenue Cycle Insider
  • 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

Other Articles in this issue of

Medicare Compliance & Reimbursement

View All