decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Limiting Charge / Overview
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Article Overview
This article explains the Medicare limiting charge concept, who it affects, and how it relates to assigned and unassigned claims. It also notes that some states impose additional restrictions on balance billing or patient cost sharing, making the topic important for physicians, anesthesiologists, non-physician practitioners, and billing staff who work with Medicare claims.
Why This Topic Matters
Understanding limiting charge policy helps billing and compliance teams avoid improper patient billing on Medicare claims and recognize when state law may impose stricter limits than federal Medicare rules.
What You Will Learn
- How Medicare limiting charge policy applies to nonparticipating providers
- The difference between assigned and unassigned Medicare claims in the context of patient billing
- Which categories of non-physician practitioners are affected by the policy
- How state-level balance billing restrictions may differ from Medicare rules
Who Should Read This
- Physicians
- Anesthesiologists
- Non-physician practitioners
- CRNAs
- AAs
- Medical billers
- Medical coders
- Compliance staff
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