This happens in CA, don’t know how it is in other states. please share your experience:
1- Patient is Medi-Medi
2- Medicare pays us 80%
3- Medical does not pay 20% because we already got paid more than Medical contracted rate (thanks god they don’t ask for money back!)
4- We cannot bill patient for 20%
NOW I just found this, I think most of you already know, for one who doesn’t know:
1- Patient is Medi-Medi
2- Patient has un-met deductible (lets say $150 out of $185)
3- Medicare pays us 80%-$150
4- In most cases, Medical doesn’t pay anything since still we got paid more than their contracted rate
Conclusion:
starting every year, we may actually loose money providing service to Medi-Medi patients! On Jan 2019 I had a patient provided L1960, Medicare paid $363 ($686*80%-$185), and Medical didn’t pay anything because their rate is $332.
I actually lost money if I consider everything such as casting tapes, AFO material, labor, staff, time with patient, adjustments, …
Do you think it’s the same for other healthcare providers?
(Sorry that sometimes I ask/share business questions here while most of you already know; I believe there are few like me who started recently)
Darya Shahrokhi, CPO
