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Next Reply: Re:Collection of patient copays & deductibles
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Post Collection of patient copays & deductibles
Author: LKrall
Date: Apr 12, 2010 11:59 am
I've read/heard some conflicting information regarding when to report the receipt of patient copays/deductibles for Medicare. With the nature of PC being what it is and the inability to collect copays upfront like a physician's office would, how have others entered this on the 1500 Form?

I heard that if Medicare receives claims that do not reflect the collection of the copayment that it could trigger an audit if they construe this as program abuse by not collecting the patient liability. Would like to know how others have handled this. Do you calculate the copayment and record it on the 1500 form before you have actually received it from the patient? If anyone is using the Medicare Pro32 software, which field(s) are you using to record the money? Thank you in advance for any advice.

Replies: order by [Date] [Author] [Subject]
+ Re:Collection of patient copays & deductibles (by JulieP on 04/15/2010)
Medicare REQUIRES a "reasonable collection effort" which is industry-defined as 3 billing cycles. Anti-kickback statutes and even the False Claims Act can be invoked to prosecute physicians that routinely do not make this effort. The mindset being that the claim is for an inflated amount if the provider does not collect coinsurance amounts hence, the bill should have been sent to Medicare for the "reduced rate".

If Medicare allows "reasonable collection effort" that means the money doesn't necessarily have to be collected up front. How can providers collect co-pays/deductibles up front for inpatient services? I've never heard of this issue before, my apologies on not being well versed. To my knowlege, we've never added information to the 1500 form on any co-pay amounts received prior to billing Medicare.
Julie Pipke-CPC, RM MCW

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