Wiki ABN Use and Co-Insurance/Co-Pay Collection

anwalden

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Coeur D'Alene, Idaho
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I work for a new ASC (we opened our doors in May), and we *finally* got our CMS approval effective 12/7/09. And I have a question regarding co-insurance/co-pay collection for patients that have Medicare replacement plans such as Sterling or Secure Horizons.

We were told that we could treat Medicare patients so long as we notified them that we were unable to bill their insurance and have them sign an ABN stating that we could not bill Medicare because we were still awaiting CMS approval.

So for example, a Sterling patient comes in for a colonoscopy. We verify their eligibility with Sterling and what their co-insurance will be for a colonoscopy in an outpatient setting. Let's say it's 10%, so on the day of surgery we collect 10% based on the Medicare allowable for outpatient centers in our area as well as have the patient sign the ABN. Is this allowed?

Basically, can we collect co-payment (not the portion the plan would normally pay) from patients with Medicare replacement plans for Medicare covered services if we were a non-covered provider?
 
Not as of yet, we're still awaiting our Medicare Provider number. We intend to become a provider with them as soon as we're able, but it's my understanding we should be able to bill retroactively to our CMS accreditation approval date of December 7th.

Our concern is over the patients we saw prior to that approval that we had sign the ABN and pay their co-insurance.
 
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