When Does Plan F Not Pay 100% of Balance?

[yogooglethis]

Just got of a 3 way call with Mayo Clinic and client to try to figure out bill.Was told by Mayo that since 3/14 as a result of CMS 's " sequestration payment adjustment " providers who don't accept accept assignment are paid 2% less from medicare and the plan F doesn't make up for this either ? I will have to adjust my plan F script a little I guess.


http://www.naic.org/documents/committees_b_senior_issues_related_cms_guidance_medigap_sequester.pdf

 

[taz]

When Medicare doesn't deem it necessary. If they are using a computer to make the incision instead of the DR. making the incision as an example.

This is the best explanation that I could have.

 

[WCMason]

Just got of a 3 way call with Mayo Clinic and client to try to figure out bill.Was told by Mayo that since 3/14 as a result of CMS 's " sequestration payment adjustment " providers who don't accept accept assignment are paid 2% less from medicare and the plan F doesn't make up for this either ? I will have to adjust my plan F script a little I guess. http://www.naic.org/documents/committees_b_senior_issues_related_cms_guidance_medigap_sequester.pdf

It is true that Medicare reduces final payment by 2%. For non-par claims, since Medicare is paying the beneficiary, the beneficiary gets reimbursed 2% less. The supplement doesn't pick up that extra 2%, even F and G. They pay their normal 20% + the excess charge only. For participating providers, where the payment goes to the provider, the provider gets 2% less and they don't get to pass that difference on to beneficiaries.

 

[yogooglethis]

It is true that Medicare reduces final payment by 2%. For non-par claims, since Medicare is paying the beneficiary, the beneficiary gets reimbursed 2% less. The supplement doesn't pick up that extra 2%, even F and G. They pay their normal 20% + the excess charge only. For participating providers, where the payment goes to the provider, the provider gets 2% less and they don't get to pass that difference on to beneficiaries.

Got it.I don't remember ever getting the memo about this.in fact i just completed my CE and I don't remember seeing it mentioned there either.

 

[WCMason]

Got it.I don't remember ever getting the memo about this.in fact i just completed my CE and I don't remember seeing it mentioned there either.

Probably not mentioned because it's not supposed to exist, and once triggered was supposed to be temporary, but given that it requires passage of a federal budget with more than a trillion in cuts, it could be "temporary" for seven more years. Or end anytime.

 

[ecotainer]

From what you have seen is it all non-par claims where the policyholder is getting balanced billed for the 2% or just claims where assignment is not accepted. My understanding was only claims where assignment is not accepted would have the policyholder on the hook for 2%.

 

[WCMason]

From what you have seen is it all non-par claims where the policyholder is getting balanced billed for the 2% or just claims where assignment is not accepted. My understanding was only claims where assignment is not accepted would have the policyholder on the hook for 2%.

My understanding is the final payee gets the cut. If Medicare pays the provider, the provider gets the cut. If Medicare pays the beneficiary, the beneficiary gets the cut. So, the policyholder should only be on the hook for non-assigned claims, as those would be the only claims where the reimbursement would go to them.

 

[ecotainer]

Thanks - that makes sense.

 

[Bob L]

My understanding is the final payee gets the cut. If Medicare pays the provider, the provider gets the cut. If Medicare pays the beneficiary, the beneficiary gets the cut. So, the policyholder should only be on the hook for non-assigned claims, as those would be the only claims where the reimbursement would go to them.

Wesley, thank you for sharing your wisdom and experience on these threads. I always appreciate what you post as it's given with a very positive, helpful tone.

You also have the patience of Job dealing with some of us on here!

Someone else asked you a year or so ago, and never saw a reply -- is that your cat in the avatar?