Medicare billing question

[ODhopeful]

Hi,
I'm new to medicare billing so I have many questions I'd like to ask, so please help. Thank you.

1. I know I have to charge patients 20% copay, then bill the rest to medicare, but is it 20% of my U&C or is it 20% of medicare allowable? I'm in the great state of Texas btw. For example, the medicare participation amount is $71.34 for a 92002, how much should I bill medicare and how much should I collect from patients.

2. Can someone please tell me how much they determine their U&C fee based on the allowable? Using the example above for a 92002, how much should I set my U&C fee? I vaguely remember something about we can't set our price higher than 115% of allowable, so in my case I should set my fee at roughly $82?

3. Also, I don't see a level 3 for 99*** or a 92*** on the fee schedule on the texas medicare website, only level 2 and 4 can be found. What happened to level 1, 3, and 5. I know doctors bill for it.

4. Sorry I know I'm asking a lot of question, just please be patient with me. If I have a NEW patient coming in with a CC of dimming in vision, and I decide it's because of his 3+ NS cataract after dilating the patient, how should I bill this encounter? Should I bill a 92*** or a 99*** and what level. I know I have to collect refraction fee from the patient. What if the patient just needs to be monitored q6months, I'm asking this because I thought to bill one of the codes, I need to initiate treatment, but if it just needs to be monitored, what do I do as far as coding?

Again, I apologize for asking so many questions. Just trying to learn how to bill correctly.

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[Tippytoe]

Delete. Private message sent.

 

[optsuker]

A site like ODWire is a better resource for this, but:

If you're a Medicare panel provider, you can charge what ever you want as a U&C fee, but only the allowed amount will be accepted. 80% will get paid to you by MC, the other 20% should crossover to their supplement automatically and the supplement will pay you that (provided deductible are met). No supplement: bill the patient 20% of allowed amount immediately.

Medicare is a discount plan, so set you U&C higher (check your local competitors/OMD's for ideas). All payble codes should be found on your regional carriers site or check CMS's site.

Using 92 or 99 codes (or a mix) is personal preference and every guru will give you a slightly different answer. My advice: use all codes and ducument well.

Lots of billing CE lectures out there. Cross Country University does a nice travelling course for Optom/Opthal. all over the US.

 

[ICOnut]

I agree. Go to courses that talk about medical billing and learn it. you may have to hire a biller, but you need to know all the rules.