Q&A: Getting reimbursed but not participating in Medicare

Get your questions answered on how Medicare impacts reimbursements.

Q: What are my reimbursement options if I am not a Medicare physician but a patient receiving Medicare assistance schedules an office visit with me anyway?

A: You are limited in what you may charge the patient; the Medicare limiting charge is 115 percent of Medicare's allowed amount. The payment is sent to the patient, so you must collect the entire amount from him or her. Many providers who don't participate with Medicare elect to file the claim accepting assignment so the payment will come directly to the practice rather than to the patient. This election reduces the payment to 95 percent of Medicare's allowed amount, so the provider loses five percent of the allowed amount simply because he or she is a non-participating doctor.

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