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General Surgery Coding Alert

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 like how your predecessor was doing things, by billing the Medicare allowable. When you bill this way, you just have to bill the patient the copay and deductible if it applies.2. The other way to bill Medicare when you participate is to bill the MAC at the full fee schedule for [...]