# Copays



## claudineerie@hotmail.com (Sep 18, 2013)

I have patients who have Medicare as primary and ACCESS (PA.) as secondary. The place I work for hasn't charged a copay to these patients for years. I looked up the copays and Medicare alone would be $6.93, while ACCESS would be $1.30 per visit. It is my understanding that the patient is responsible for $1.30 copay, is this true??? Thaks for the help!!!!


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## ABridgman (Sep 18, 2013)

As far as I know, Traditional Medicare hasn't charged any co-pay - we have never collected any.  What state are you in?


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## RFoster1 (Sep 18, 2013)

Assuming you are referring to the patient's 20% coinsurance, I would begin collecting the difference between MC's 20% pt responsibility and what the secondary covers.  Typically these have to be billed after the claim has paid unless you are able to pin down the exact amount before the claim pays.


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## gkaufman (Sep 18, 2013)

You must try to collect co-pay amounts from Medicare patients just as you would any other insurance.  Collection efforts must be documented before a write-off occurs.  Consistent write-off without collection effort is deemed as program abuse.


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## ABridgman (Sep 18, 2013)

co-insurance, yes.  But what CO-PAY should be being collected from Traditional Medicare?  Not MA plans, but TRADITIONAL Medicare?

Doctor in PA.

As an aside, my mother is on Medicare and her doctor is in NJ, she has Tradional Medicare, and has never been charged any co-pay.

Now this is off the AARP website, and says nothing about Part B co-pays...
Copays: In traditional Medicare (Parts A and B), you pay 20 percent of the Medicare-approved amounts for most Part B services. In Part A, after meeting the deductible you pay nothing more for up to 60 days in the hospital in any one benefit period, but additional days may require daily copays. In Part D and Medicare Advantage plans, you pay the copays required by your plan.

http://www.aarp.org/health/medicare-insurance/info-04-2011/medicare-cost.html

Additionally, medicare.gov says nothing about any co-pay for Part B services on Traditional Medicare.
    Part B annual deductible: You pay $147 per year for your Part B deductible in 2013.
    Clinical laboratory services: You pay $0 for Medicare-approved services.
    Home health services:
        $0 for home health care services.
        20% of the Medicare-approved amount for durable medical equipment.
    Medical and other services: You pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.

Again, no mention about any CO-PAY.  Co-insurance, yes.  Not co-pay.


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## KMCFADYEN (Sep 18, 2013)

Traditional Medicare does not have co-pay only co-ins.


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## dclark7 (Sep 18, 2013)

Traditional Medicare does not have a co-pay, but some secondary insurances do.  Not Medi-gap policies, but some employer sponsored retirement policies second to Medicare do require co-pays.  These should be either collected at the time of service if you know them, or billed to the patient after Medicare and the secondary have paid.


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## ABridgman (Sep 18, 2013)

KMCFADYEN said:


> Traditional Medicare does not have co-pay only co-ins.



See, now that is EXACTLY what I thought!

Now I know some MA plans have a co-pay, but not Traditional Medicare!


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## claudineerie@hotmail.com (Sep 18, 2013)

Pennsylvania


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## claudineerie@hotmail.com (Sep 18, 2013)

yep, it is co-insurance for medicare and a copay for ACCESS which is my question, I guess. I need to know whether we charge the patient the ACCESS copay because Medicare direct bills the secondary, even though we receive a higher payment from the primary than the secondary would give to us.


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## ABridgman (Sep 18, 2013)

Now that is a good question, about ACCESS.

I know that ACCESS - Medicaid, routinely pays nothing on secondary, because the primary always pays more than the Medicaid allowance in the first place - and, of course, we are not allowed to charge the patient for the amount ACCESS isn't paying...

So, on a Medicare service costing $100 allowed by Medicare, they would pay $80 and pass along $20 to ACCESS.  ACCESS probably only allows $25 for the same service, and Medicare already paid $80, so ACCESS pays nothing on the claim and we end up having to write off the balance as a Contractural Obligation.  But whether or not we should be charging those patients the ACCESS co-pay is an interesting question.

Personally, my own guess would be no, that co-pay would probably only apply when ACCESS was the Primary - and by definition, the ONLY insurance - because Medicaid is ALWAYS the last Payer.  I could not say for sure on that since our doctor does not take Medicaid patients - we have a couple patients with Medicaid Secondary, and we never charged them any co-pay for the ACCESS - would be good to know if we are supposed to be doing so.

NOT always, but usually, I have observed other secondary insurances in the private sector - not having co-pay amounts.  So I'd assume ACCESS was the same way - the co-pay would probably apply to Medicaid Primary patients.  By the way, we also are in Pennsylvania.  Different states might have different policies concerning Medicaid, since that is state-level.


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