tci General Surgery Coding Alert - 2012 Issue 7

Reader Question: What's the 'Right Way' to Bill Medicare?

Question: As a participating Medicare provider submitting claims to Trailblazer (J4 MAC), I have a billing question. My predecessor billed only the Medicare allowable for each code, but I bill Medicare at our full practice fee schedule. When payment arrives, we post the allowable and contractually adjust off the remaining portion and/or apply the appropriate amount to the patient deductible per the CMS remit. Am I doing it right, or was my predecessor? New Mexico SubscriberAnswer: Both methods are technically correct. Practices bill Medicare in two different ways:1. Some practices bill Medicare at the Medicare fee schedule. That sounds...

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