Wiki Writing off the Medicare coinsurance if secondary is out-of-network

[CatchTheWind]

If Medicare pays 80% of the allowance and then forwards the claim to the secondary, but the secondary denies due to our not being in network, is it legitimate for us to write off the 20% for this reason, or are we still required to bill the patient?

 

[daedolos]

Make sure the patient isn't a QMB first.

Peace
@_*

 

[thomas7331]

The CMS and OIG publications on this issue have taken the position that patient coinsurance/deductible should not be routinely waived, but may be forgiven if the provider has made a good-faith attempt to collect payment and has determined that the patient is unable to pay due to financial hardship. I don't think that a denial as out-of-network would meet this requirement since the patient would still be responsible - it would not be appropriate to write it off without first attempting to collect the balance from the patient.