Medicare Part B schedule is the amount Medicare will pay a provider for a covered procedure. For example, a certain surgery may cost $1000 but Medicare will only approve $500 on that particular surgery. You are responsible for 20% of the Medicare approved amount, Medicare pays 80%. You will receive an explanation of benefits from Medicare showing the approved amount and what your responsibility would be, based upon the fee schedule.
CMS (Center for Medicare Services) determines how much they will pay for medical services. Doctors, hospitals, clinics, labs, etc. that treat Medicare beneficiaries are required to accept the fee schedule.
If the provider accepts Medicare assignment they are prohibited from balance billing.
If they do not accept Medicare assignment, they are allowed to charge a higher amount but must adhere to the Medicare caps on excess charges.
.JPG){kind=avatar}
If the provider accepts Medicare assignment they are prohibited from balance billing.
If they do not accept Medicare assignment, they are allowed to charge a higher amount but must adhere to the Medicare caps on excess charges.
Medigap plan F and G will cover excess charges.