tci Medicare Compliance & Reimbursement - 2023 Issue Q1

Reader Question: Understand These Billing Rules for Medicare-Covered Services

Question: Can a practice send a Medicare beneficiary an advanced notice of noncoverage for a service that Medicare actually covers? One of the providers at our practice thinks the payment rate for a certain procedure is too low through Medicare and knows the patient can afford to pay cash. AAPC Forum Participant Answer: If the provider is participating as a Medicare provider — no. In the Medicare Learning Network (MLN) booklet “Medicare Advance Written Notices of Non-Coverage,” the Centers for Medicare & Medicaid Services (CMS) specifically says that participating providers cannot transfer payment liability to a patient...

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