Home Forums Discussions General Discussion Sequestration Reductions

Ok, I have started getting EOBs from Medicare showing a 2% reduction in payments, presumably from the sequestration BS. BUT, the EOB still shows the "allowed amount" as the amount that was allowed before. So, if I am entitled to the Medicare allowed amount, then someone needs to pay me that, right? If not Medicare and not the secondary then, the way I see it, the patient should have to. The allowed amount is still the same but now, rather than paying 80% of the allowed amount, Medicare is only paying 78%. Anybody interpret this differently?

I just read the official statement on the CMS site...you cannot bill the patient. So, why did the CMS not just reduce the allowed amount instead of having us have to jump through another stupid accounting hoop???

Because government bureaucrats function from the mindset of control and directive.

They do not care how much work they make for you, but they are imperative about you NOT doing things that highlight them negatively.

I absolutely agree with you about the logic; what other market can a customer tell you unilaterally they are going to pay you less AND that you cannot seek out the balance of transaction from the other parties to the transaction.

It is price controls and a misguided belief that they can control the market by directive. In human history, it has never been successful for long, and it is another marker for the end-stage of a system.

The salient question is what comes next.

Because they want you to notice it on every EOB and be angry. Republican answer
Because if we lower the allowed amount you might not get it back. Democratic answer

My understanding is the "allowed amount" for that procedure code will not change. But somewhere on the EOB it should reflect the 2% reduction. You can not bill the patient for more than the EOB states "patient responsibility". All these new rules are confusing, by the time you figure them out and how to implement them, it's too late.

Though I am not happy about the sequestration cut, I am quite relieved that the allowable does not seem to be changing. All of my commercial contracts are based on a % of medicare allowable so only Medicare pts are being cut and not everyone....so far.

Bill: good answer. Do you actually make LESS on your commercial contracts than Medicare? (Our worst payer).

No, I make more but they pay based on Medicare allowable.