Chapter 4: Medicare Non-Participating Providers Flashcards
What are providers called who choose not to participate in Medicare?
Nonparticipating providers (nonPARs).
NonPARs can still see Medicare patient, but they don’t contract with Medicare and do they agree to Medicare’s approved payment rate?
No
NonPARs also must file all claims for patients coveted under the Medicare program, does Medicare sends payment for services directly to the patient?
Yes.
Nonparticipating providers are subject to a limit regarding what?
What can be charged to Medicare beneficiaries for covered services.
Nonparticipating providers are subject to a limit regarding what can be charged to Medicare beneficiaries for covered services is known as?
The Limiting Fee.
What is the Limiting Fee?
15% over Medicare’s approved amount for noPARs.
What is an approved amount for a nonPAR?
Is 5% below the approved amount for a PAR.
