tci Medicare Compliance & Reimbursement - 2008 Issue 29
Part B Claims: Non-Par Providers Must Submit Claims On Patient's Behalf
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Article Overview
This article discusses Medicare Part B billing responsibilities for non-participating providers and physicians who have opted out of the Medicare program. It summarizes CMS guidance on when claims may be self-submitted by beneficiaries, and it explains the related claim-filing expectations for providers and practices in different participation scenarios. The content is relevant to medical billers, coders, practice managers, and providers who handle Medicare claims.
Why This Topic Matters
Understanding these Medicare Part B claim submission rules helps practices avoid improper billing workflows and align office procedures with CMS policy for non-par and opted-out care.
What You Will Learn
- How Medicare Part B claim submission differs for non-participating and opted-out providers
- What CMS guidance says about beneficiary self-submission in certain situations
- How claim filing responsibilities relate to emergency and non-emergency care
- Why practices need procedures for handling Medicare patients seen under different participation statuses
Who Should Read This
- Medical billers
- Medical coders
- Practice managers
- Physicians
- Healthcare administrators
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