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More Doctors Accept Standard Medicare Fees

January 25, 1985

WASHINGTON (AP) _ A record number of physicians accepted Medicare’s standard fees for their elderly patients’ bills in November, the Department of Health and Human Services said Friday.

Sixty-six percent of all Medicare claims were paid that way in November, John Kitrell, a spokesman for the Health Care Financing Administration, said.

In October, the first month of fiscal 1985, more than 62 percent of physicians and suppliers accepted Medicare’s rates. That was up from 56 percent for all of fiscal 1984 and 50.5 percent in fiscal 1977.

Congress last year froze physicians’ fees under Medicare but also gave them incentives to sign up to accept Medicare claims ″on assignment.″

That means that the physicians agree to charge no more than what the government has set as their maximum fee for a service. They then bill the government for 80 percent of the fee, and bill the patient for the remaining 20 percent.

If the physicians do not accept Medicare’s rate as the maximum, they can charge the patient whatever they want, but they must collect the entire amount from the patient. The government then reimbuses the patient for 80 percent of its regular rate.

Normally, about one doctor in five accepts Medicare’s rates as the maximum in all cases. Currently, almost 30 percent of the nearly 400,000 physicians and group practices that regularly treat Medicare patients have signed up for the program. Among the incentives to sign up was a provision allowing them to report Medicare increases in their fees during the freeze.

Although Medicare will not pay them more during the freeze, it will keep track of the higher charges and allow them to bill at higher rates once the freeze ends. Medicare’s fee structure is built around what physicians report as their customary and reasonable charges.

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