Medicare Compliance & Reimbursement - 2008 Issue 28
Part B Claims: Even Non-Par Providers Must Submit Claims on Patient's Behalf
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Article Overview
This article covers Medicare Part B billing responsibilities for providers who do not participate in Medicare, including non-par and opted-out arrangements. It discusses recent CMS guidance on claim submission, beneficiary self-submission in limited circumstances, and the practical implications for practices that treat Medicare patients. The content is relevant to coders, billing staff, practice managers, and providers who need to understand when claims are filed by the provider, the patient, or not at all under Medicare rules.
Why This Topic Matters
Understanding these Part B claim-filing requirements helps practices avoid billing problems and stay aligned with Medicare administrative policies when treating beneficiaries.
What You Will Learn
- How Medicare Part B claim submission is handled for non-participating and opted-out providers
- What recent CMS guidance means for claims submitted by beneficiaries
- How emergency and non-emergency care are discussed in the context of Medicare billing responsibilities
- What practices should consider when treating Medicare beneficiaries after opting out or leaving participation
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physicians
- Compliance personnel
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