Practice Management Alert

Question: I have been told that it is wise to collect deductibles before patients see the doctor, including Medicare patients, if I can find out how much of a patients annual Medicare deductible has been met. If I collect any of the deductible before filing the claim with Medicare and receiving an explanation of benefits (EOB) to see what services were allowed, could I run the risk of illegally charging the patient for services that Medicare does not allow?

Kansas Subscriber
       
 
Answer: A practice is expected to know reasonably what Medicare covers. Most practices are familiar with what Medicare allows and pays for services they commonly perform. If Medicare may not cover the services, the patient must sign an advance beneficiary notice (ABN) prior to receiving the services. The notice says the patient understands that the services may not be covered by Medicare and will be responsible for the bill for the noncovered services. If the patient does not sign the statement, he or she cannot be billed for noncovered services. Noncovered services are not subject to the $100 annual deductible or any coinsurance.
 
Medicare permits physicians to collect deductible and coinsurance amounts for services before the claim is submitted or processed. If the deductible status is known, you can charge the beneficiary the amount of unmet deductible and 20 percent of the approved charge in excess of the unmet deductible. If the deductible status is unknown, the beneficiary can be charged the lesser of the approved charge for the service or $100 plus 20 percent of the remaining approved charge. If you collect any charges from the beneficiary before submitting the claim, you must show the amount collected on the claim form. Then, if the deductible or coinsurance amount is incorrect, such as when the patient already met the deductible or if Medicare doesnt allow the charge, the carrier will refund the beneficiary directly and collect the refund from the medical practice.