rlerma
Contributor
Can someone please help me? I work for a clinic that does not accept insurance of any kind, we have a pt who submitted for reimbursement on chiropractic care. He has brought in his EOB that has us a bit confused.Could someone please explain the following paragraph:
THIS PROVIDER DOES NOT PARTICIPATE WITH MEDICARE. UNDER FEHB LAW (5 U.S.C.8904 (B)), WE ARE REQUIRED TO BASE OUR PAYMENT ON THE MEDICARE FEE SCHEDULE AMOUNT OR THE PROVIDER'S CHARGE WHICHEVER IS LESS FOR SERVICES PROVIDED TO FEDERAL RETIREES AND ANNUITANTS WHO ARE AGE 65 OR OLDER AND ARE NOT ENROLLED IN MEDICARE PART B. SINCE THIS PROVIDER DOES NOT PARTICIPATE WITH MEDICARE, HE/SHE CAN BILL YOU UP TO THE MEDICARE LIMITING CHARGE. YOU ARE NOT RESPONSIBLE FOR ANY AMOUNTS OVER THE MEDICARE LIMITING CHARGE. THE MEDICARE LIMITING CHARGE MAY BE CALCULATED AS 115% OF THE ALLOWANCE. PLEASE SEE YOUR BLUE CROSS BLUE SHIELD SERVICE PLAN BROCHURE FOR MORE INFORMATION.
YOUR RESPONSIBILITY TO THE PROVIDER IS $31.20 WE PAID $17.64
THE PROVIDER CAN COLLECT $31.20 FROM YOU FOR THESE SERVICES.
We charge $55.00 for manipulations at the time of visit, do we need to change our charge rates?? We do not do any insurance billing.
Any help would appreciated greatly!!
R
THIS PROVIDER DOES NOT PARTICIPATE WITH MEDICARE. UNDER FEHB LAW (5 U.S.C.8904 (B)), WE ARE REQUIRED TO BASE OUR PAYMENT ON THE MEDICARE FEE SCHEDULE AMOUNT OR THE PROVIDER'S CHARGE WHICHEVER IS LESS FOR SERVICES PROVIDED TO FEDERAL RETIREES AND ANNUITANTS WHO ARE AGE 65 OR OLDER AND ARE NOT ENROLLED IN MEDICARE PART B. SINCE THIS PROVIDER DOES NOT PARTICIPATE WITH MEDICARE, HE/SHE CAN BILL YOU UP TO THE MEDICARE LIMITING CHARGE. YOU ARE NOT RESPONSIBLE FOR ANY AMOUNTS OVER THE MEDICARE LIMITING CHARGE. THE MEDICARE LIMITING CHARGE MAY BE CALCULATED AS 115% OF THE ALLOWANCE. PLEASE SEE YOUR BLUE CROSS BLUE SHIELD SERVICE PLAN BROCHURE FOR MORE INFORMATION.
YOUR RESPONSIBILITY TO THE PROVIDER IS $31.20 WE PAID $17.64
THE PROVIDER CAN COLLECT $31.20 FROM YOU FOR THESE SERVICES.
We charge $55.00 for manipulations at the time of visit, do we need to change our charge rates?? We do not do any insurance billing.
Any help would appreciated greatly!!
R
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