Wiki Medicare and non-par Urgent Care

[melissamiller]

I work for an Urgent Care and we have been billing Medicare patients through our family practice, because somewhere along the line they thought you can't bill to Medicare unless you are participating, is this true? I read that if you are non-par and accept assignment on your claims they will process, is this true? If we are non-par, do we have to credential with Medicare?

Thank you for any help or guidance.

 

[dclark7]

Are you non-par or have you opted out? These are two totally different situations. You can find info and billing guidelines at cms.gov. Basically if you are non-par you can determine on a case by case basis if you will accept Medicare assignment and you can bill Medicare. You still must follow Medicare regulations and can only collect a certain amount above the allowable. However Medicare also pays you less than a participating provider. If you have opted out you cannot bill Medicare except in certain emergency situations.

I'm not familiar with the rules for Urgent Care (i.e. are they considered a facility as opposed to private practice). But you should be able to find the information you need at the cms website.

 

[AlaskanCoder]

Do you have to be enrolled to bill Medicare? I have a pediatrician who has a 7-yr old patient with Medicare primary and a commercial insurance secondary. I checked with Medicare and this is the correct order. I have never seen a peds patient with Medicare before, so I don't know how to handle this. All of my other providers have been participating.
So, do I just bill Medicare on paper to get a denial?
Thank you,
Karen Hill, CPC, CPMA

BTW: one of my other providers is an Urgent Care and they are not a facility, they are treated the same as a private practice.