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	<title>New answer on: Medicare Part B Excess Charges?</title>

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		<title>By: Jeffrey VanCleve</title>

		<link>https://insurancelibrary.com/medicare-insurance/medicare-part-b-excess-charges</link>

		<dc:creator>Jeffrey VanCleve</dc:creator>

		<pubDate>Mon, 16 Mar 2015 16:35:21 +0000</pubDate>

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		<description><![CDATA[Physicians do have a third option besides &quot;Participating&quot; or &quot;Non-Participating&quot;.  The can become a private contracting physician (opting out of Medicare), agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves.  This is rare however, fewer than 1% of all physicians are private contractors.  Due to limiting charges, Medicare reimbursement penalties, and administrative collection costs, Part B excess charges are an extreme rarity and not something to be concerned with.  It&#039;s a non-issue in the states mentioned in a previous reply, and any Medicare beneficiary can make it a non-issue by checking that your services provider is a Participating provider in Medicare.]]></description>

		

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		<title>By: Jason Goldenzweig</title>

		<link>https://insurancelibrary.com/medicare-insurance/medicare-part-b-excess-charges</link>

		<dc:creator>Jason Goldenzweig</dc:creator>

		<pubDate>Tue, 03 Feb 2015 15:09:17 +0000</pubDate>

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		<description><![CDATA[In short, Part A is your hospital insurance and Part B is your physician insurance.  Excess charges falls under what a doctor can bill you for.

If you read an outline of coverage of a plan F or a plan G (whichever carrier&#039;s outline you want to look at doesn&#039;t matter - the plans are standardized so the input is the same regardless of company), you will see that Medicare Part A pays all but specified amounts during a hospital stay (as an inpatient) as follows:

1) First 60 days - Medicare Part A pays for all but $1,260.  Medigap plan F and G pay the deductible for you.
2) Days 61-90 - Medicare Part A pays for all but $315 a day.  Medigap plan F and G pay the $315 a day for you (30 days totals up to $9,450).
3) Days 91+ (while using 60 lifetime reserve days) - Medicare Part A pays for all but $630 a day.  Medigap plan F and G pay the $630 a day (60 reserve days totals up to $37,800).
4) Once lifetime reserve days are used, additional 365 days - Medicare Part A pays $0.  Medigap plan F and G pay 100% of Medicare-eligible expenses up to an additional 365 days.
5) Beyond the additional 365 days - Medicare Part A pays $0.
*Note - that&#039;s per benefit period!  A benefit period begins on the first day you receive services as an INPATIENT and ends after you&#039;ve been out of the hospital for at least 60 days in a row.  It&#039;s possible to have more than one benefit period in the span of a year.  Inpatient stay coverage per benefit period includes semi-private room and board, general nursing, and miscellaneous services and supplies.

Please also note, you can be in a hospital for a day or two and still be listed as an outpatient.  If you&#039;re unsure, you should ask your doctor if you&#039;re listed as an inpatient or outpatient in their system.

Unless you&#039;re admitted as an inpatient, you&#039;re being treated as an outpatient which is where your Medicare Part B coverage comes into play.  Part B pays about 80% of medical expenses leaving you responsible for the other 20% (covered by plans F and G).  If a doctor accepts Medicare assignment, they accept the Medicare-approved amount as payment in full.  If they do not accept Medicare assignment, they can bill you an excess charge - which are covered by plans F and G.

If you live in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont, you cannot be charged excess charges by a doctor due to the Medicare Overcharge Measure laws.

I hope the information is helpful - please feel free to contact me for help with your coverage and if you have any other questions.  Thanks very much.]]></description>

		

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		<title>By: marksquires</title>

		<link>https://insurancelibrary.com/medicare-insurance/medicare-part-b-excess-charges</link>

		<dc:creator>marksquires</dc:creator>

		<pubDate>Tue, 03 Feb 2015 14:48:21 +0000</pubDate>

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		<description><![CDATA[&quot;Excess Charges&quot; only occur with Part B coverage.
Whether or not a Medicare Beneficiary may be subjected to Part B Excess Charges by a provider depends entirely on how the provider is contracted with Medicare. 
When the provider choose their method of contracting with Medicare they must choose whether they will be &quot;Participating&quot; or &quot;Non-Participating&quot;. 
This terminology may be confusing but it really is not.
&quot;Participating&quot; simply means the provider will accept the Medicare assignment of the Medicare approved amount as payment as total payment (Medicare&#039;s part) for services rendered.
&quot;Non-Participating&quot; means the provider has chosen to not necessarily accept the Medicare approved amount as total payment (Medicare&#039;s part) for services rendered and may choose to charge the beneficiary up to 15% of the Medicare approved amount (in addition to the beneficiary&#039;s cost sharing amount). The provider may choose on a case-by-case basis whether to seek excess charges from the beneficiary.
This rule applies ONLY to physician fee schedules thus applies only to Medicare Part B charges.
So it depends entirely upon whether the provider has chosen to contract as a &quot;Participating&quot; or &quot;Non-Participating&quot; provider with Medicare. 
If you are in doubt it may be beneficial to contact the office manager at your provider&#039;s office and ask whether the provider is &quot;Participating&quot; or &quot;Non-Participating&quot; as it applies to Medicare approved payments.

All the best.
Mark]]></description>

		

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