SI
SI
discoversearch

We've detected that you're using an ad content blocking browser plug-in or feature. Ads provide a critical source of revenue to the continued operation of Silicon Investor.  We ask that you disable ad blocking while on Silicon Investor in the best interests of our community.  If you are not using an ad blocker but are still receiving this message, make sure your browser's tracking protection is set to the 'standard' level.
Politics : A US National Health Care System?
 Public ReplyPrvt ReplyMark as Last ReadFilePrevious 10Next 10PreviousNext  
To: Lane3 who wrote (11099)11/5/2009 2:08:37 PM
From: i-node1 Recommendation  Read Replies (1) of 42652
 
>> No. Doctors don't have to participate in Medicare and more are choosing not to.

I think we have a terminology thing here. There are three possibilities --

a) Provider is a participating provider -- i.e. he accepts assignment of the claim,

b) Provider is a nonparticipating provider -- he sees Medicare patient but doesn't take assignment of the claims, or

c) Provider doesn't see Medicare patients, or sees them on a self-paying basis only.

For (a) and (b) the provider must be enrolled and I'm pretty sure must file the claims. But for (b) he is reimbursed at the nonpar rates and can seek payment from the patient, whereas with (a) he takes Medicare's reimbursement plus the patient share and calls it even.

But if the provider isn't enrolled (enrolled, but as a nonpar provider), I don't think Medicare will accept a claim for services they provided, even if you filed it yourself.

If a provider is going to see Medicare patients, he either needs to be participating or just agree up front to be fully paid by the patient and accommodate them by filing a claim, because Medicare is going to cut the check to the patient.

We had a customer last year who was making some changes to their enrollment and Medicare screwed it up and set them up as nonpar. Suddenly, they stopped getting money from Medicare and the checks were all going to patients -- a disaster, since patients will just cash the checks and spend the money instead of paying their medical bills with it. That's why most docs take assignment (even though they have to take a cut in the reimbursement rate to do it).
Report TOU ViolationShare This Post
 Public ReplyPrvt ReplyMark as Last ReadFilePrevious 10Next 10PreviousNext  

HomeMailHotSubjectMarksPeopleMarksKeepersSettings
Terms Of UseContact UsCopyright/IP PolicyPrivacy PolicyAbout UsFAQAdvertise on SI
© 2026 Knight Sac Media.  Data provided by Twelve Data, Alpha Vantage, and CityFALCON News