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Is it Medicare fraud for a company to bill commercial insurance companies a higher fee-for-service than they are billing Medicare for the same service?
Insurance companies negotiate rates for services at the best advantage to them. Companies with larger groups get the best rates becaues they have more economic leverage. Medicare is the 900 pound gorilla in the insurance world. So the short answer is no, it is not fraudulent. The reason is each insurance company will pay at their own negotiated rate regardless of how much the provider charges.
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Answer Yes. Check the plan brochure for how much and what percentage.
Doctor issued prescription for Mothers wheelchair. Ordered from company who now claims they do not deal with Medicare insurance. Mother billed entire cost on her CC. What recourse can be used now?
First, never order anything without checking whether or not a medical supplier works with Medicare. There are numerous suppliers who do work with Medicare and sell wheel…chairs. If order was placed knowing that the company did not deal with Medicare, then one has basically shot themselves in the foot as to any recourse against that company. Always - always - Read the fine print in any documents. You can try to file a claim directly with Medicare. They may reimburse you for a portion of the cost, but maybe not. Perhaps you can return the chair for at least a partial refund and order one from another supplier.
This is directly from the Medicare and You 2009 Book: When you have other insurance, there are rules that decide whether Medicare or your other insurance pays first…. The insurance that pays first is called the "primary payer" and pays up to the limits of its coverage. The one that pays second, called the "secondary payer," only pays if it covers any of the costs left uncovered by the primary coverage. If you have other insurance, tell your doctor, hospital, and pharmacy so your bills get paid correctly. If you have questions about who pays first, or you need to update your other insurance information, call Medicare's Coordination of Benefits Contractor at 1-800-999-1118. TTY users should call 1-800-318-8782. You can view the details here: http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf
Can they rebill medicare again if I received a bill from the hospital almost 2 years after spouses death because insurance company made a mistake am I responsible because medicare should pay rest?
Medicare would have covered all the remainder if my insurance had not made the error "Can they rebill medicare again I received a bill from the hospital almost 2 years after s…pouses death because insurance company made a mistake am I responsible because medicare should pay rest?"
Are Dr's Offices required to bill the insurance company direct or is this done a service to the customer?
It depends what the contract between your health insurance and the doctor says. Generally its being done as a service to the customer.
I would say maybe United HealthCare and Mutual of Omaha are the two biggest currently.
No. What many people do not understand is that providers DO NOT determine their own reimbursement rate. When providers decide to join a network, for example Aetna, t…hey are provided with what is called a fee schedule. The fee schedule has a list of pricing, set by Aetna that by signing the contract with Aetna, the provider is agreeing to the set fee structure set by Aetna. Should the provider bill Aetna $525.00 for a procedure which is listed on the fee schedule at $250.00, the provider will be paid at $250.00 every time, nothing more. Each insurance company sets their own pricing, so the overall answer to your question is, NO it is not fraud for a provider to bill Medicare at a higher rate than another insurance company for the same service, it is completely dependent on what the insurance company set the pricing at.
The insurance company with the first responsibility for payment of a bill for medical services is known as?
The Primary is the first responsiblity of medical billing and if you have dual then the secondary will cover what the primary does not if not its out of pocket or Dudctible
The Doctor I used to go to violates HIPPA double dips the Medicare system Charges the patient and pockets the money and then bills the insurance company How can this be reported?
Call the Medicare fraud hotline at 1-800-HHS-TIPS (1-800-447-8477). Do the same thing for the insurance company(ies).
What is the name of the insurance company with the first responsibility for payment of a bill for medical services?
Yes. If the medical provider wants to challenge the denial then the medical provider must submit his request for reconsideration within a certain time limit. The bill-er would… have to contact the insurance company to find out when the time limit ends and if the denied claim can be re-billed with special documentation.
No. It is health cost payment program funded by the US Govt.
Different companies have different regulations. For example, credit card companies each offer similar products but the different between them comes in the structure of interes…t rates and their acquisition.
There are dozens of Medicare supplement insurance companies to choose from. AARP, Colonial Penn Life, and Gerber Life Insurance are just a few of the more popular companies.
Medicare supplement insurance pays for the cost of hospital and medical care that's not covered by Original Medicare. Insurance companies that provide this cover include Combi…ned Insurance Company of America, Family Life Insurance Company, Globe Life and Accident, Liberty National and Transamerica.
Medicare is a government subsidized medical insurance program. There is no company called "Medicare Billing". Medicare billing information, however, can be found on the United… States Government Medicare website.
Obviously, it's a fraud because a contract of insurance is acontract uf Utmost good faith technically known as uberrimafides.So, billing for a service not performed is a breac…h ofcontract and is liable for penal action by the insurance companyagainst the policy holder committing the crime, leading tocancellation of the whole claim vis a vis denial for renewal ofpolicy in future.