Medicare limits on physician charges

2 Pages·1992·0.08 MB·English

by  United States. Health Care Financing Administration

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MEDIC
LIMITS ON PHYSICIAN CHARGES
Manydoctorsagreeto"acceptassignment"onallorsomeoftheir
Medicareclaims. Thismeansthedoctorsagreetoaccepttheamount
approvedbytheMedicarecarrierastotalpaymentforcovered
services.
A
Thereisalimitontheamountadoctorwhodoesnotaccept
assignmentcanchargeyouforMedicare-coveredservices.UiwS
FederalLaw,yourdoctorcannotchargemorethanthischargelimit.
• In1991,themostyoucouldhavebeenchargedis140percent
oftheprevailingchargeforofficevisitsand125percentofthe
prevailingchargeformostotherservicesofphysicianswhodo
notacceptassignment.
• In1992,themostyoucanbechargedis120percentofthe
Medicareapprovedamountforphysicianswhodonotaccept
assignment.
• In1993,thelimitwillbe115percent.
Reviewyour"ExplanationofYourMedicarePartBBenefits"notices
toseeifchargesforyourdoctors'serviceshaveexceededtheselimits.
Ifyouareunabletodeterminethelimitingchargeforspecific
services,youcancontactyourMedicarecarrier.
Ifyouthinkyourdoctorhasexceededthechargelimitforservices
youhavereceivedsinceJanuary1,1991,youshouldcontactthe
doctorandaskforareductioninthecharge,orarefund,ifyouhave
paidmorethanthechargelimit. M^'
Ifyoucannotresolvetheissuewiththedoct^youcancallyour
Medicarecarrierandaskforassistance. -..--^
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M4335
1992
HCFAPub.02164 •U.S.GovernmentPrintingOffice:1992—312-143/60940