Typical Charges for 20% of Outpatient Services
- Thread starter AOKING
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You are welcome. Tips greatly appreciated.
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good resource! tks
- 1,199
good app if you want to be very very conservative on pricing but Medicare allowable rates are usually much less
for example:
Cataract Surgery according to blue book
Total Fair Price:$3,559
20% would be 711.18
20% allowable charges on medicare typically about 300-400.00
20% MA contracted rate typicallly about 200-300
Exactly. Healthcare Bluebook provides a competitive billed charge. MADP use the lower Medicare fee schedule allowed amounts as a starting point and then negotiates with providers for even lower allowed amounts further reducing co-insurance.
Certainly no reason to use a resource like the bluebook when you can always just SWAG it. Good luck with that approach.
Personally, I never tell a client what their charges/OOP might be on a particular claim. If they press, I refer them to the bluebook. If their OOP is higher they can't pin it on me.
40 years without an E&O claim. No reason to start now.
Personally, I never tell a client what their charges/OOP might be on a particular claim. If they press, I refer them to the bluebook. If their OOP is higher they can't pin it on me.
40 years without an E&O claim. No reason to start now.
- 1,199
Not a good idea to mention co insurance prices at all to consumers but I thought this was a forum for agents to talk shop.i thought the OP might be interested in the factoid that medicare part b allowable charges are usually way lower than commercial health insurance and that MA negotiated charges are usually even lower
you can search what was how much was paid for each service by physician here.
Medicare Unmasked: Behind the Numbers - WSJ.com
This was news to me so I asked a MOM about this phenomena. Her response.
When Medicare Advantage plans started, they were set up without contractual obligations on the part of the provider and promised to pay Medicare rates. My experience with Medicare Advantage plans is that they pay as well or better than Medicare. Since they are non-contractual, if they do not pay the same rates, then doctors should not see the patients.
Also, Advantage plans, being commercial, do not have the regulations that Medicare plans have. For example, only a Physical Therapist can bill Medicare for Message Therapy, and it cannot be billed incident to. In Advantage plans, a mid level, massage therapist, can bill for Massage Therapy incident to a physician.
As to your question, MA should not be paying less than Medicare and if the plan is then the doctor should review his charges to ensure that he is charging the Medicare rate or higher. If his charges are correct, then drop that MA patient.
