General Surgery Coding Alert

Question: Must we always collect Medicare patient copays and deductibles, and how do I know how much the patient must pay out of pocket?

Texas Subscriber

Answer: Yes, you should always collect copays and deductibles, or face legal consequences. According to the HHS Office of Inspector General (OIG), “the routine waiver of Medicare coinsurance and deductibles can violate the federal Anti-Kickback Statute if one purpose of the waiver is to generate business payable by a federal health care program.” In addition, offering inducementslike cost-sharing waivers to influence a patient’s provider selection can violate other statutes, the OIG says.

2019 money matters: Traditional Medicare pays 80 percent of the allowed charges, leaving the patient to make a 20 percent copayment. In 2019, the Medicare Part B deductible is $185, and the Medicare Part A deductible is $1,364. Those are the amounts the patient must pay before the coverage kicks in.

For more information, check out the MLN Matters release on Medicare Deductible, Coinsurance and Premium Rates for 2019 at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11025.pdf.