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Medicare advantage programs

Leslie Posted Tue 17th of November, 2009 14:34:36 PM

I was told I could bill the patients 15% over what medicare allows for those who have the Medicare Advantage programs. Our office does par with upstate medicare, blue sheild medicare, mvp medicare and cdphp medicare. No contract with Todays options, Horizon Blue shield, AARP and many more. These companys say that becasue they allow 100 percent of medicare and we cashed the check we can not. I just need to know what it right. Thanks Marie Office Manager for Leslie B. Breiten

SuperCoder Answered Thu 19th of November, 2009 14:15:49 PM

The 15% extra you have mentioned is allowed to a provider who has signed the private fee-for-service (PFFS)contract under the Medicare Advantage Program. Providers under this contract are required to accept not more than 115% of the contracted rate as the full payment for their service . Here is a link that will give you a clear picture: http://www.medicareadvocacy.org/FAQ_ManagedCare.htm

Hope it helps.

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