# Medicare write offs



## nluppi

Can a physician write off a coinsurance amount required after Medicare and Medicaid has made payment.


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## Pam Brooks

Not categorically.  Make sure you do your research first.  You should have a solid financial aid policy in place before you write off any patient responsibility for which you are contractually obligated to collect.  

_Medicare's Fraud and Abuse Guide's “Examples of Improper Waiver of Deductible and Copayments,” outlines, “marketing practices that may be suspect to charge-based providers” includes “(Non-) Collection of copayments and deductibles only where the beneficiary has Medicare supplemental insurance (“Medigap”) coverage (i.e., the items or services are “free” to the beneficiary,” and “Failure to collect copayments or deductibles for a specific group of Medicare patients for reasons unrelated to indigence.”_


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## nluppi

Thank you for the information.  You verified what I had anticipated. 

Do you know how I can get an exact copy of the guidelines to show to our physicians?


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## Sheri1997

*Financial aid policy*

I am looking for a financial aid policy to adapt to our practice.  The ones I have found are several pages long and require the patient to bring in proof of income.  My physician feels that it is a time consuming endeavor for the staff to monitor and determine if the patient falls into guidelines.  Can someone link me to a concise, practical policy?  And any  guidelines I should follow.  Thank you.


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## cyndeew

I know you asked for something that isn't pages long and your doctor doesn't want you tied up with verifying income and deciding if someone qualifies. Unfortunately, it's not that easy. You have to have something documented as to why you are forgiving patient's amounts owed or reducing them. It's the only proper way - you have to have a policy, be able to supply it to patients and be able to make a qualified determination. In order to do that, you need to be able to explain it to your patients and have an application. Here are some policies you could use to adapt your own:

http://r.search.yahoo.com/_ylt=A0LE...2012.pdf/RK=0/RS=CW3mgUseqhZAC0dW7s0giORZ.ck-

http://r.search.yahoo.com/_ylt=A0LE...Form.pdf/RK=0/RS=3_Zp.NwsqBk8.35fESPc_PmREps-


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## teresabug

I worked for a physical medicine/rehab doctor. He required any patient that said "I can't afford my bill" to sign a legal-binding waiver and we got the pt's previous years' tax return along with their monthly utility bills. The doctor reviewed this info. One patient had over $100,000 in the bank. It pays to do legwork. 
My motto is 90 days and out the door to a collection agency and dont see the patient again until they pay.


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## sande78705

*write offs*

My original interpretation of the question was write off after MCR and Medicaid had made payments. I am thinking that the pt has both insurances. In my practice we call it a Medi/Medi adjustment. The patient is not responsible for anything after the two insurances have paid.
If I read the question wrong, I am sorry


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## MnTwins29

sande78705 said:


> My original interpretation of the question was write off after MCR and Medicaid had made payments. I am thinking that the pt has both insurances. In my practice we call it a Medi/Medi adjustment. The patient is not responsible for anything after the two insurances have paid.
> If I read the question wrong, I am sorry



Don't feel bad Sandi, I read the question the same way.  And...if Medicaid paid after Medicare, isn't the Medicaid payment supposed to be accepted as fulfilling the coinsurance requirements in full?   Here in NY State, Medicaid will pay 20% of the 20% coinsurance after the Medicare payment, and that is complete - no further patient responsibility.


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## suemt

To answer this question, you need to be clear on where the patient responsibility originated.  

If the patient responsibility or coinsurance is from Medicaid, such as a patient on a spend down or sliding scale, then you need to collect the balance from the patient.  All the previous suggestions for a charity/financial aid assessment/process apply.  

However, if the patient responsibility or coinsurance is from Medicare, the patient may not be responsible.  You need to fully understand the Medicaid remittance.  

Many states have implemented a Medicaid "cap" where the provider cannot receive more than Medicaid would have paid for the service overall.  In these instances, you may not bill the patient for the difference.  But if you are an institutional provider, you can claim this in your Medicare Cost Report as Medicare Bad Debt.  

If the Medicaid payment was not capped, you should make sure that all the charge lines were paid and pay close attention to the reason code for any charge line that isn't paid in full by Medicaid.  

Does this help?


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## malbertson

This has been a super helpful thread to me too, as we need a more firm financial hardship policy in place at my current practice! 

Right now I am learning the ropes of Medicare/Medicaid, and I must admit my head spins at times. Even though my daughter is a Medicaid recipient, seeing it from the other end is wildly confusing at times.


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