Participating versus Non-Participating Doctors

Understanding Medicare Medical Payment Schemes

By Staff Reporters

www.HealthcareFinancials.comHOFMS

As of 1992, Medicare invoices are paid per resource-based relative value unit (RBRVU), and according to the lesser of the actual billed charges or the fee schedule amount. But, there are two types of medical providers: 1. Doctors who accept Medicare assignment only bill the patient for the co-payment, which is usually 20%.  2. Doctors who do not accept Medicare assignment are offered a lower fee schedule of 95% of the approved schedule, which is a 115% maximum fee limit of the approved schedule.

Example:

A participating physician’s approved fee schedule charge of $100 would yield $80 from Medicare and $20 from the patient. A non-participating (Non-Par) doctor with charges of $200, and with an approved fee schedule of $100, would yield: $109.25 = (.95 X $100) X 1.15 entirely from the patient.

If the Non-Par doctor selects payment type on a case-by-case basis, Medicare will pay its portion of the bill directly to the physician, but the doctor must accept the Non-Par fee schedule.

Assessment

Continuing our example yields: (.8 X $95) plus the patient’s co-payment of (.2 X $95), OR $76 plus $19 = $95.00.  

Conclusion

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New ME-P Features in Review

Quick Links to Innovation and Integration

By Ann Miller; RN, MHA

[Executive Director]

IntegrationRecently we have added several new features to the Medical Executive-Post. And so, below is an aggregated and integrated list, with hot links, for your easy access and review.

We trust you will use, and enjoy them, frequently.

  

ME-P Features:

1. Our photo sharing feature called ME-Pr:

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8. ME-P blog rating and ranking system.

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9. Editorial complaints and publishing corrections.

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10. Videos and graphic slideshows.

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Assessment

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Conclusion

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