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Fee schedules laws ( COMPLIANCE AND LEGAL)

Lysa Posted Tue 12th of January, 2016 15:16:41 PM

About 15 yrs ago I was working for an EMR company and I remember that the laws changed to state that you are only allowed 1 fee schedule. In other words, being able to charge each insurance company different fees for the same CPT was illegal. so hypothetically, a 99213 with a charge of $100 to Medicare must have the same charge to BCBS and all other insurances. I have looked on the Medicare website, reached out to OIG and cant find the legal answer. Can you help?

SuperCoder Answered Wed 13th of January, 2016 09:18:43 AM

Thanks for the Query

According to Medicare Private Fee-for-Service Plan the insurance company, rather than the Medicare Program, decides how much you pay for the services you get.

Lysa Posted Thu 11th of February, 2016 17:01:44 PM

This does not answer the question. The question is are you allowed to have 1 charge for medicare and a different charge for any commercial carrier? for example- If I have a 99213, can I charge medicare $100, BCBS $120 and AETNA $150 and then WC $1000?

I am not interested in any payment info- I want to know the legal compliance around charges going out. ALSO, I need a link which shows that this is the case...not just an answer. I will need proof. please help. I purchased this product to be able to get answers, and this hasnt been helpful at all. :-(

Lysa Posted Thu 11th of February, 2016 17:01:52 PM

This does not answer the question. The question is are you allowed to have 1 charge for medicare and a different charge for any commercial carrier? for example- If I have a 99213, can I charge medicare $100, BCBS $120 and AETNA $150 and then WC $1000?

I am not interested in any payment info- I want to know the legal compliance around charges going out. ALSO, I need a link which shows that this is the case...not just an answer. I will need proof. please help. I purchased this product to be able to get answers, and this hasnt been helpful at all. :-(

SuperCoder Answered Fri 12th of February, 2016 09:14:29 AM

Hi,

Please go through below link from medicare website and feel free to ask further query.

https://www.medicare.gov/Publications/Pubs/pdf/10144.pdf

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