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ADJUSTMENT ON A DEDUCTIBLE

Lori Posted Wed 13th of June, 2012 15:10:19 PM

THE INSURANCE STATES THE PATIENT HAS A DEDUCTILBE ON A CERTAIN PROCEDURE EX..74.50 ON A OAE.. CAN WE ADJUST THAT AMT OUT AS A COURTESY TO THE PATIENT?? OR DO WE HAVE TO BILL THE PATIENT 74.50??

SuperCoder Answered Wed 13th of June, 2012 16:36:01 PM

Lori,

Thank you for your question! I don't know which insurer you're billing, but many follow Medicare guidelines. A similar question was posted on the WPS Medicare site and that MAC answers it quite thoroughly, so I have posted the Q&A below. It also includes a reference to the applicable CMS manual that governs this issue:

From http://www.wpsmedicare.com/part_b/faqs/departmental/fee_faq.shtml#q3:

"Question: I understand that Medicare takes the deductible and coinsurance amounts into consideration when determining the reasonable charge for a service or item. When a patient is not able to pay his/her annual deductible or coinsurance, how can I determine when it is okay to write-off the charges, without violating the law that pertains to kickbacks and false claims? What can I do to verify financial hardship?

Answer: It is important that providers not write-off coinsurance and/or deductibles until the provider establishes the financial hardship of the beneficiary. Providers must make a reasonable effort to collect payment from the beneficiary. A reasonable effort would entail the issuance of a bill to the beneficiary or responsible party. The provider should also follow-up with subsequent billing, collection letters, and telephone calls. A genuine effort to collect payment is necessary before writing off these charges. Providers should never routinely write off deductible and coinsurance charges.

The Centers for Medicare & Medicaid Services (CMS) addresses this issue in the Internet-Only Manual (IOM), Publication 100-4, Chapter 23, Section 80.8.1. To view a copy of this publication, please refer to the CMS website below:
http://www.cms.gov/manuals/downloads/clm104c23.pdf"

I hope this reference helps!

Best,

Torrey Kim, CPC, CGSC
Editor-in-Chief
Part B Insider
www.eliresearch.com

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