As a Medical Biller, the better you understand the medical insurance payment process, the better you can care for your patients. Your understanding of what a patient will owe and what will be covered can help them navigate the confusing world of medical insurance.

One term that can be very confusing for patients (and for doctors as well) is the difference between a PAR Provider and a Non-PAR Provider.

The main difference between the two types is:

A ‘Par provider’ is a doctor who accepts assignment.

A ‘Non-Par’ provider is a doctor who does not accept assignment.

The other primary differences are:

– A different fee amount is charged between Par and Non-Par Providers
– Medicare chooses to pay a different amount to each type
– Medicare sends the payment to the doctor instead of the patient when it is a Par Provider, and to the patient when it is a Non-Par Provider

Typically, a Par Provider bills Medicare directly an amount equal to the Medicare ‘Par Fee’.

Medicare pays the provider directly for 80% of the “Par Fee”. The patient is then responsible for paying the provider the 20% co-insurance amount (which may be covered by a secondary policy if the patient purchased such coverage).

A ‘Non-Par’ provider bills Medicare directly an amount called the Medicare Limiting Charge.

The Limiting Charge is set at 15% higher than the Non-Par Fee. The NonPar Fee is 5% less than the Par Fee.

Typically, Medicare will pay the patient directly for 80% of the ‘Non-Par Fee’. The patient is then responsible for passing on the Medicare payment to the provider, plus paying for the 20% co-insurance on the ‘Non-Par Fee’ as well as the 15% difference between the ‘Non-Par Fee’ and the ‘Limiting Charge’. (portions of which may be covered by a Secondary Policy if the patient purchased such coverage).