Practice Management Alert

Question: Can we collect Medicare coinsurance payments before the patient leaves the office?

Florida Subscriber

Answer: Each MAC (Medicare Administrative Coordinator) handles coinsurance differently, so check with yours. As a general rule, you are not required to wait for reimbursement instruction before you can bill and collect coinsurance.

Remember, for coinsurance - and as general best practice - you need to verify the patient's coverage upfront. If the coverage checks out, you can collect coinsurance before the patient leaves the office.

There are a couple specifications to keep in mind:

For Medicare Advantage patients, who have defined contribution amounts, you can collect a patient's coinsurance amount when she checks in. Some electronic software will continuously calculate an individual patient's coinsurance and deductibles, so you can even give the patient a head's up as to the exact amount she'll owe when she arrives for her appointment.

For patients with Part B, you can change the patient within the window of after he's finished his appointment but before he leaves the office. You'll need to read the patient's chart to see which services the physician performed, and you can then collect coinsurance as the patient checks out.