tci Medicare Compliance & Reimbursement - 2012 Issue 10

Reader Question: How Should You Bill Medicare?

Question: We are participating with Medicare. We bill and submit claims to Trailblazer (J4 MAC). 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. However, my predecessor was billing only the Medicare allowable for each code? Am I doing it right? Or was she? Answer: Both methods are technically correct. Practices bill Medicare in two different ways: 1. Some practices bill Medicare at the Medicare fee schedule. That sounds like how your predecessor was doing things, by billing the Medicare allowable...

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