Confused About how Medicare Excess Charges Work?

[jvancleve]

This is one of the best write-ups I have seen.....

Medicare Participation Options for Physicians -- Running a Practice -- AAFP

 

[eharriett]

Thank you. that was actually pretty useful.

 

[jvancleve]

Thank you. that was actually pretty useful.

You're welcome. One observation about the following statement:

Non-PAR physicians would need to collect the full limiting charge amount roughly 35% of the time they provided a given service in order for the revenues from the service to equal those of PAR physicians for the same service. If they collect the full limiting charge for more than 35% of the services that they provide, their Medicare revenues will exceed those of PAR physicians.

Although this may be true, physicians seek profit above just revenue; and know there are costs associated with collecting full limiting charges from patients as a non-PAR physician. Medicare pays non-PAR claims directly to the patient beneficiary, so the non-PAR physician must collect in full from the patient beneficiary. Thus Non-Par physicians would need to collect the full limiting charge at some percentage greater than 35% of the time in order for the profits from the service to equal those of PAR physicians for the same service. This helps further explain why the vast majority of physicians participate in Medicare. J. VanCleve