Posted by Team KMCU on Nov 1, 2024
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Myth or Truth:
You Must Charge Your Medicare Advantage Patient the Medicare Limiting Fee When You Are Not Contracted with Their Plan
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Why do so many people have their hands in the pot of your office pocketbook? Ensure you know the rules for charging Medicare Advantage patients when you are out of network with their plan. It may seem like you should be able to do your own thing. Medicare Regulations are clear on this topic. Check this video out to learn more about charging Medicare Advantage patients for their medically necessary spinal CMT services. We’ve seen the other side of this with a KMC University client. They can and will enforce this.
Comments on Do You Charge Your Medicare Advantage Patient the Medicare Limiting Fee?
Thank you for this information. Questions…
Some Medicare Advantage Plans have Out Of Network benefits and their own “allowable'” limiting fee. They are sending payment to us. Do I use that Medicare Advantage plan fee schedule or the Medicare fee schedule?
Thank you, again! I appreciate all you do to keep us informed.
Another question or 2…
When did rule take effect? How far back do we need to make adjustments?
Also, if the Out Of Network Medicare Advantage plan applies their allowable / limiting charge to the deductible, do we adhere to that or charge the patient the Medicare allowable rate?
Thank you, again.