Reader Question: Understand These Billing Rules for Medicare-Covered Services
Question: Can a practice send a Medicare beneficiary an advanced notice of noncoverage for a service that Medicare actually covers? One of the providers at our practice thinks the payment rate for a certain procedure is too low through Medicare and knows the patient can afford to pay cash.
AAPC Forum Participant
Answer: If the provider is participating as a Medicare provider — no.
In the Medicare Learning Network (MLN) booklet “Medicare Advance Written Notices of Non-Coverage,” the Centers for Medicare & Medicaid Services (CMS) specifically says that participating providers cannot transfer payment liability to a patient...
To read the full article, sign in and subscribe to tci Medicare Compliance & Reimbursement.
Keep pace with evolving Medicare regulations — and onboard your team — with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI's Medicare Compliance & Reimbursement Alert will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, payer policies, the fee schedule, OIG target areas, and more.
Current newsletters added each month
Fully searchable archives - over 4200 articles
ALL years/issues back to 2003 organized by year and issue
Codes mentioned in articles are linked to Code Information pages
Code Information pages link back to related articles
Access to this feature is available in the following products: