Medicare approved amount vs. Medicare paid amount, what's the diff?

[goillini52]

Why not obscure the patient’s name and scan the document then put it up here so we can see it?

Because he's the patient and he doesn't want us to know that he had an implant.

 

[goillini52]

Ok, I think I finally have an idea about what is going on.

It is based on a concept I found in this article:
Medicare Payments for Outpatient Therapy

My idea is vague. It centers around the concept that Hospital OutPatient Billing Departments that do not accept assignment are apparently not subject to limiting charges like individual providers, such as doctors.

So the MSN (i.e. Insurance Company EOB), in "allowing" the full billing, becomes an authorization for the Medicare Part B service provider to bill the Medicare Beneficiary for all of the provider charges not paid by Medicare, IF the provider (hospital facility) does not accept Medicare assignment.

The MSN would look similar to pages 1 and 5 of this document,
https://www.cms.gov/Medicare/Medica...ads/Sample-Part-B-Medicare-Summary-Notice.pdf

Except it would say Facilities with Claims This Period on page 1 and the two left hand amount columns on page 5 would be equal as I showed in a post above.

Negotiated pricing.

 

[LostDollar]

Because he's the patient and he doesn't want us to know that he had an implant.

actually not, but it makes a nice story!

 

[bpenn9]

Hang around. You may learn something.

I've learned that I'd rather be involved in some amazing agent FB groups then this site anymore. Thanks Lost Dollar.