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What Is a Non-Covered Service?



Patients enjoy medical coverage by health insurance companies for services such as prescription drugs and medical care services. However, Medicare and private payers do not pay for non-medical services. In some cases, Medicare rules permit physicians to bill patients for services under non-covered services through billing services for doctor offices.


A physician should understand those rules and apply them to avoid non-payments from the patient. For instance, in 2018, a Comprehensive Error Testing Program (CERT) report, a body mandated to measure inappropriate billing in Medicare Free-For –Services (FFS), showed a 41 percent error rate for chiropractic services claims.


Services that Medicare Does Not Cover


Bundled services

These are services which payments are entitled to another entity, such as workers compensation.


Non-covered services

  • Cosmetic surgery: procedures aimed at improving the patient's look

  • Hearing aids: prescription examinations, changing and fitting hearing aids

  • Foot care: treating flat foot, or devices meant for supporting the foot.

  • Eye checkup: such as eye examinations and changing eyeglasses

  • Services and supplies that are considered medically unreasonable and unnecessary.

A non-medical service must meet the National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) regulations and requirements in the statute to get Medicare coverage. And the physician should indicate the signs and symptoms that make the service necessary and reasonable. If that strategy fails, a patient can rely on billing services for doctor offices.


How to Collect Payments for Non-Covered Services

As stated earlier, Medicare rules allow the physician to bill the patient if they need services that are not covered by Medicare cover. However, before reimbursing such services, the physician should first check the payer's websites and get the coverage information. If the policy is unclear concerning the specific service, the physician should let the patient know that they'll pay for the services from their pockets.


If the patients get billing services for doctor offices, the physician should give them a written notice, known as Advanced Beneficiary Notice of Noncoverage (ABN). This notification will help the patient decide if they will get the services and pay for them if Medicare fails to deliver.


In many instances, physicians go through a tough time while trying to follow the payer's guidelines. So, it is advisable to hire the services of medical billing services providers. These experts know how to collect payments for non-covered services.

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