Show ins R Charges Charge Social Security Explains Reasonable i. i The voluntary medical Insurance insurance ance part of Medicare helps elps pay reasonable charges for physicians' physicians services and other medical services covered by the program We tWe have had some difficulty getting people to un understand understand understand un- un just what a reasonable charge Is said Don Donaldson Donald Donald- son social security district manager In Provo Utah A doctors doctor's charge Is looked at from two different viewpoints In determining how much of It Medicare can recognize and pay payas payas payas as a reasonable char charge First the law requires examination of the doctors doctor's customary charge charge- that Is what he usually charges his patients for the service Medicare reimbursement cannot cannot cannot can can- not be more than the customary charge Second the law re requires requires requires re- re quires a determination of the prevailing rate among physicians physicians physicians In the locality for the same service and prohibits Medicare reimbursement ex exceeding exceeding exceeding ex- ex that rate Blue Cross the health In Insurance Insurance insurance In- In organization which handles Medicare claims In 10 Utah keeps records of charges for services and determines the reasonable charges for those services The prevailing rate is determined according to regulations regulations regu regu- lations Issued by the Social Security Administration Under those regulations the prevailIng prevailing prevail prevail- ing charge for a service Is what 75 percent of the physicians physicians physicians in the area customarily charge for that service If the physicians physician's charge Is his customary customary customary cus cus- tomary charge and Is no higher than the prevailing rate Medicare Medicare Medicare Medi Medi- care will pay 80 percent of the charge If however the charge exceeds the prevailing charge Medicare pays no more than 80 percent of the prevailing rate If a doctors doctor's charge is higher high high- er than the Medicare reasonable charge it could mean one of three things 1 that the charge exceeded his customary charge 2 that the charge fell among those made by doctors in the area whose charges exceed the 75 percent prevailing limit or 3 that the doctor has increased his charge but the increase has not been in effect long enough to have been en established as customary In Medicare rec rec- Medicare pays 80 percent of the reasonable charges for services covered by the medical medical medical medi medi- cal Insurance program after the 50 annual deductible has been incurred The deductible will be 60 beginning January 1 1973 If the doctor and the patient agree the doctor can file me the Medicare claim and payment will be made directly to him In that case the doctor doctor doctor doc doc- tor also agrees to accept Medicare's Medicare's Medicare's Medi Medi- cares care's reasonable charge as full payment for the service and can bill the patient only for forthe forthe forthe the 20 percent of reasonable charges which Medicare does not pay If the patient submits the claim himself Medicare will pay 80 percent of the reason reason- able charge directly to him and he Is responsible for the doctors doctor's full bill even though It is more than Medicare pays A representative of the Social Security Administration will be u at the Manti Mantl County Courthouse Courthouse Court Court- house basement north en entrance entrance entrance en- en trance December 19 A calendar calendar calendar cal cal- notice of his quarterly visits will be posted at most public buildings during 1973 His hours are to pm p.m. |