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?

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?

• A. 10%
• B. 15%
• C. 20%
• D. 50%

Answer: (B)

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%.

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%.