A provider can charge more than the Medicare-approved amount, subject to what limit?

The provider can charge more than the Medicare-approved amount, subject to the limiting charge. The limiting charge is a specific percentage of the Medicare-approved amount that a non-participating provider is allowed to charge a beneficiary for covered services. This percentage is set by Medicare and helps protect patients from excessive fees by ensuring that the additional amount charged remains within a reasonable limit.

When a provider is non-participating, they may choose to bill the patient for the difference between what Medicare pays and what they charge, but this is capped by the limiting charge rules. Understanding this concept is crucial for those working in medical administration as it helps manage patient billing practices and ensures compliance with Medicare regulations.