Forum - Questions & Answers

Feb 6th, 2015 - DrDoggoff 3 

Maximum collection for a Medicare patient.

I am at the end of my medicare op-out period. I am not enrolled as a provider in any medicare plan yet. I know that I can no longer private contract with medicare patients, but When I do the CMS search I come up with multiple columns of prices. I believe that I would be non-facility as an independent private practitioner. Then there are still several dollar amounts that are listed such as limiting charge. So ... what column do I use to charge medicare patients when my opt-out term is over.

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Feb 6th, 2015 - LBAROGIANIS 250 

re: Maximum collection for a Medicare patient.

I believe you would be non fac non par

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Feb 6th, 2015 - DrDoggoff 3 

re: Maximum collection for a Medicare patient.

Thanks but, these are the four columns that are returned with the search:
1 NON-FACILITY PRICE
2 FACILITY PRICE
3 NON-FACILITY LIMITING CHARGE
4 FACILITY LIMITING CHARGE
Each have a different $value. So I have the narrowed the field to #1 or #3.

CODE...|Short Description...........|...#1....|....#2..|...#3....|...#4...|
99214..|Office/outpatient visit est.|..$112.94|..$83.11|..$123.39|..$90.79|

So I can legally collect either $112.94 or $123.39? I would rather have column 3 apply :) but not sure if it is the allowable charge...

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Feb 7th, 2015 - DrDoggoff 3 

re: Maximum collection for a Medicare patient.

Does anybody know the answer? What column do you use to charge patients? How do you figure out out?

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Feb 8th, 2015 - dsteed   141 

re: Maximum collection for a Medicare patient.

I would use the limiting charge column. It is generally for opted out providers who are non-participating, non-facility, but still held to a ceiling of charging, about 115% of Medicare allowed.

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