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Medicare colllections

David Posted Thu 11th of April, 2013 13:28:37 PM

I have an associate that is advising me that my office is not allowed to collect up front on the coinsurance from Medicare patients. These patients do not have a secondary insurance and will be billed for the 20% that Medicare leaves to their responsibility. It has been our policy to collect this amount from the patient at the time of the visit but my associate is advising that there has been a change in the Medicare policy this year and you can only accept payment from that patient at the time of the visit if the patient forces the payment on you and you have to make a note in their chart that this was the case. My associate claims that this change is because Medicare may not allow the claim, therefore I have over-collected from the patient. Is this true? Can you send me any documentation you have on this please?

SuperCoder Answered Tue 16th of April, 2013 01:27:27 AM


My editor is working on this.She will get back soon with the reply.


SuperCoder Answered Tue 16th of April, 2013 11:09:42 AM

Hi there! I am not aware of any law restricting you from collecting up-front, but in some cases, it's difficult to know how much to collect at patient registration (prior to the visit), since you aren't completely sure what the doctor is going to do once the patient is in the examining room. Typically practices are comfortable collecting up front for defined contribution copayments, which many Medicare Advantage programs offer, since they don't depend on which services you render. In most cases, however, your best bet is to collect coinsurance after the patient has seen the doctor (but before they leave the office that day; in other words, have them pay the coinsurance at checkout).

Some electronic subscription services allow you to verify the patient's coinsurance amount and whether their deductible has been met before the patient arrives for his visit. This can help you calculate what to charge the patient in coinsurance at check out based on what the physician did that day.

Most insurers leave this decision up to you, but you don't want to end up collecting way too much because then you must issue the patient a refund, creating an extra step in your process. Check with your payer to ensure that it doesn't have any requirements about this, and if not, create your office policy around these guidelines.

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