The limiting charge is a percentage limit on fees that nonparticipating physicians may bill Medicare beneficiaries above the non-PAR fee schedule amount. What is the limiting charge?

Prepare for the RHIA Reimbursement Test with multiple choice questions, each accompanied by hints and explanations. Ace your exam with confidence!

The limiting charge is set at 15% above the non-participating physician's fee schedule amount for services provided to Medicare beneficiaries. This regulation ensures that while non-participating providers can bill more than the established fee schedule, there is a cap on the additional amount to protect beneficiaries from exorbitant charges beyond what Medicare allows. By capping this limit at 15%, the Medicare program helps maintain a balance between fair compensation for healthcare providers and affordability for patients receiving care. Therefore, the answer regarding the percentage limit that non-participating physicians may charge above the fee schedule is indeed 15%.

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