Quote:
Originally Posted by blueash
Balance billing is when the doctor has a charge, say 1000, and the insurance only allows 500, but instead of writing off that 500 the doctor bills the patient for the amount not covered by insurance. Sort of how most dental coverage now works. We have all seen those blood test bills of 800 fee and the insurance allows 27 and somehow makes a profit while writing off the 773.
Should this system be eliminated specifically for Medicare patients? The idea is that perhaps more doctors will accept Medicare if they can bill and collect whatever they charge, some from Medicare and the rest from the patient. This might incentivize some doctors to come to our area as taking care of Medicare patients will result in much higher income than taking care of the rest of the population where there are write offs on the insured and non-collection on the uninsured.
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This thread opens a subject that is extremely complicated and would require a book to set straight, so I'll try to confine the discussion in response to 3 posts, starting with this one
"Balance billing" is a non-issue since 1/1/1992. All Medicare participating physicians, by law, are required to accept the Medicare reimbursement for each CPT code, based on the RVRBS value in their geographic area. You can "charge" whatever you want, but you MUST accept the value of the service as payment in full.
To give an example, Medicare allows about $57.90 for code 99213 (short office visit to address 1 problem such as blood pressure). They pay 80% of that number, and the patient or their supplement pays the other 20%. You can charge $300 for that code, but you MUST take $57.90 as payment in full. You can call the difference between $300 and $57.90 a "write off" if you want,, but it is NOT tax deductible, and all it does is cause accounting headaches. You CANNOT bill this difference.
So why do physicians charge more than the allowable amount on paper? First of all, there is private insurance. To charge less than an insurer will pay is just plain stupid. Second, believe it or not, reimbursement is occasionally increased, so you don't want outdated fees. Some practices carry this to the extreme. We set our "fee", which is ultimately an arbitrary number, just above the reimbursement of the best private insurance. BTW, Medicare fees are not terrible. Most private insurers set their reimbursement based on Medicare rates, usually 112-118% thereof. But some providers "charge" way above that. Example: Our in office lab charged $25 for a chem profile. The best insurance would pay $23.60, Medicare paid $13.85. The lab next door charged $385 for the same test, and got the same $13.85 from Medicare. The people who get "screwed" are those with no insurance, and I agree 100% with the poster above who stated that is not fair.
Now, if you CHOOSE to go to a physician in Beverly Hills or Naples, or a concierge physician that does not participate in Medicare, regardless of insurance, the whole bill is YOUR responsibility. They might submit the insurance paperwork, but essentially you will be paying the majority of the cost out of pocket. The same holds true for Mayo, or Laser Spine Institute, or Cancer Treatment Centers of America, so beware.
As far as access to care goes, 93% of all physicians in the US participate in Medicare, so there is no need for additional incentive to participate (at least not yet)