decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Charges for Medicare Services / Overview
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Article Overview
This article explains general Medicare charge considerations for physician and anesthesia practices, with emphasis on how federal fraud and abuse concerns can arise when Medicare charges differ from usual charges. It also touches on how private managed care arrangements are treated differently and references an advisory opinion from the Office of Inspector General. The piece is useful for billers, compliance staff, and practice managers who want a high-level understanding of charge-setting issues and the general billing concepts discussed in the article.
Why This Topic Matters
Charge patterns can affect compliance risk, especially when Medicare pricing is compared with a provider’s usual charges. Understanding the broad policy framework helps practices review fee schedules and billing approaches more carefully.
What You Will Learn
- How Medicare charge comparisons relate to usual charges in a practice setting.
- How private managed care arrangements are treated differently from other patient charge categories.
- How federal guidance and advisory opinions are discussed in relation to charge thresholds.
- The general context for multiple-procedure charge adjustments in non-insurance billing discussions.
Who Should Read This
- Physician practice managers
- Medical billers and coders
- Anesthesia billing staff
- Compliance professionals
- Revenue cycle teams
Codes Discussed
Modifiers Discussed
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