Medicare Excess Charges in ER

[LostDollar]

Surprised by a medical bill? Here's what to do - CNN.com

Given one of the 10 locations referenced in the article, the comments there may have some bearing on the specific situation discussed.

 

[somarco]

Kirby, the urgent care reference was a response to Dollar's comment in #8

 

[VolAgent]

Kirby, the urgent care reference was a response to Dollar's comment in #8

I realize that, I was responding to the second paragraph.

 

[LostDollar]

So we are back to non-par providers who contract with a hospital in any capacity, including ER. Are such providers allowed to forgo assignment?

Comments under this question:

Q: What should a group practice consider when establishing participation agreement(s) with Medicare?

In this article:

Medicare participation decision FAQs-MGMA - MGMA

Seem to be suggesting that if the provider bills individually under his/her own practice name, the provider can be non-participating even if the medical facility in which the services are provided is participating. ??

 

[somarco]

I could be wrong, but it is my understanding there is only one UPIN/NPI per doc. Makes no difference if the bill goes out under the name of the practice or doc.

 

[LostDollar]

https://www.cms.gov/Medicare/Provid...SupEnroll/downloads/EnrollmentSheet_WWWWH.pdf

Didn't know what an NPI was-went hunting-an information recap sheet above.

That looks like it goes along with the idea of participating non-participating based on billing choices.