Which term refers to the limits on the amount non-participating physicians can charge beneficiaries?

The term that refers to the limits on the amount non-participating physicians can charge beneficiaries is known as the Limiting Charge. This concept is significant in the healthcare billing process, particularly under Medicare guidelines. Non-participating physicians are allowed to set their own fees; however, they must adhere to the Limiting Charge, which serves as a cap on how much more they can charge beneficiaries over the Medicare fee schedule. This ensures that while patients have access to a variety of providers, they are also protected from excessive out-of-pocket costs.

In the context of non-participating physicians, understanding the Limiting Charge is crucial because it governs their billing practices and safeguards beneficiaries from exorbitant charges. It helps maintain some level of affordability and predictability for patients seeking care from these providers.

The other terms listed do not accurately reflect this specific context. The Maximum Allowable Charge typically refers to the highest amount that an insurance company will allow for a particular procedure or service but is not specific to non-participating providers alone. The Limit Charge is a less formal term and is often used interchangeably with the Limiting Charge but does not carry the same regulatory weight. Billing Code Limit does not pertain to the charges imposed by physicians and instead relates to coding