What Does Medicare Approved Mean?

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   Ted Ratliff

   Owner, SFS Associates,

   Any time you have a claim, Medicare must approve the medical necessity of that claim and the amount they will pay.  If a claim is not approved Medicare will not pay.  Medicare when paying claims has a set payment they will approve for a specific procedure based on how that procedure is billed.  Medicare will only pay 80% of that approved amount for Part B covered charges.  A doctor cannot bill for more than 15% of the Medicare approved charges.  Some states like Ohio do not allow the 15% excess charges.  A doctor who accepts Medicare cannot balance bill for more than the approved amount.

   Answered on May 27, 2013

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