RE: Medicare co-pay & deductible

[Guest guest]

not me.

My work is to continually be explaining to patietns how things work You

see, many patietns think that the 80% measn you get 80% of your fee.

My medicare patietns in general are actualy the most infomed bunch i have

and more than any other group they ask if I got paid yet, and they read

EOBs and say it is a pity how little I get.

the mre we take time to explain things to patietns t he more we empower

them to change the system.

Medicare co-pay & deductible

For those on the list that still accept Medicare: does anyone write off

that 20% or the annual deductible that the patient is responsible for?

We still get patients that expect us to just accept the 80% that

Medicare pays as payment in full, which blows my mind. They say that

there are docs out there that do that. Is that true? That is business

suicide, if so. I doubt anyone on this list does this, but I'm just

curious how common the practice is.

[Guest guest]

not me.

My work is to continually be explaining to patietns how things work You

see, many patietns think that the 80% measn you get 80% of your fee.

My medicare patietns in general are actualy the most infomed bunch i have

and more than any other group they ask if I got paid yet, and they read

EOBs and say it is a pity how little I get.

the mre we take time to explain things to patietns t he more we empower

them to change the system.

Medicare co-pay & deductible

For those on the list that still accept Medicare: does anyone write off

that 20% or the annual deductible that the patient is responsible for?

We still get patients that expect us to just accept the 80% that

Medicare pays as payment in full, which blows my mind. They say that

there are docs out there that do that. Is that true? That is business

suicide, if so. I doubt anyone on this list does this, but I'm just

curious how common the practice is.

[Guest guest]

Only Illinois medicaid gets to right off medicare copay and deductible here in Illinois. We expect our patients to pay the 20% not covered by medicare. However, if they do not have a secondary insurance that crosses over automatically, I am sure we only break even collecting $9.91. Brock DO wrote: For those on the list that

still accept Medicare: does anyone write off that 20% or the annual deductible that the patient is responsible for? We still get patients that expect us to just accept the 80% that Medicare pays as payment in full, which blows my mind. They say that there are docs out there that do that. Is that true? That is business suicide, if so. I doubt anyone on this list does this, but I’m just curious how common the practice is.

Access over 1 million songs - Yahoo! Music Unlimited.

[Guest guest]

Only Illinois medicaid gets to right off medicare copay and deductible here in Illinois. We expect our patients to pay the 20% not covered by medicare. However, if they do not have a secondary insurance that crosses over automatically, I am sure we only break even collecting $9.91. Brock DO wrote: For those on the list that

still accept Medicare: does anyone write off that 20% or the annual deductible that the patient is responsible for? We still get patients that expect us to just accept the 80% that Medicare pays as payment in full, which blows my mind. They say that there are docs out there that do that. Is that true? That is business suicide, if so. I doubt anyone on this list does this, but I’m just curious how common the practice is.

Access over 1 million songs - Yahoo! Music Unlimited.

[Guest guest]

My

understanding is that it is illegal to write off the co-pay or the deductible

(unless you are Medicaid). The thinking goes like this… if you are

willing to accept 80% of the allowable then technically you are billing Medicare

20% more than what you are willing to accept (which Medicare interprets as insurance

fraud). So, by doing a simple act of kindness, you actually set yourself up for

a lawsuit. Yes, exceptions can be made, but it has to be clear that these patients

are the exceptions are not the rule.

Medicare co-pay & deductible

For those on the list that still accept Medicare: does

anyone write off that 20% or the annual deductible that the patient is

responsible for? We still get patients that expect us to just accept the

80% that Medicare pays as payment in full, which blows my mind. They say

that there are docs out there that do that. Is that true? That is

business suicide, if so. I doubt anyone on this list does this, but

I’m just curious how common the practice is.

[Guest guest]

My

understanding is that it is illegal to write off the co-pay or the deductible

(unless you are Medicaid). The thinking goes like this… if you are

willing to accept 80% of the allowable then technically you are billing Medicare

20% more than what you are willing to accept (which Medicare interprets as insurance

fraud). So, by doing a simple act of kindness, you actually set yourself up for

a lawsuit. Yes, exceptions can be made, but it has to be clear that these patients

are the exceptions are not the rule.

Medicare co-pay & deductible

For those on the list that still accept Medicare: does

anyone write off that 20% or the annual deductible that the patient is

responsible for? We still get patients that expect us to just accept the

80% that Medicare pays as payment in full, which blows my mind. They say

that there are docs out there that do that. Is that true? That is

business suicide, if so. I doubt anyone on this list does this, but

I’m just curious how common the practice is.

[Guest guest]

Almost, but not quite right. Medicare sets a fee schedule, lets say $54 for a 99213 (and say your fee is $80). Medicare then pays you 80% of the $54 if you are participating, the patient is expected to pay the other 20% of the $54. That is after they have met their deductible. But either way, it is based on CMS fee schedule. If you are non-participating you can charge whatever your fee is, medicare pays 80% of whatever their fee schedule is for non-participating doctors (I think it is less than for participating docs) and you can bill the remainder of your entire fee to the patient.

Back to the question of deductibles, I know many of the commercial carriers are letting people check deductible balances when you (or if) you check eligibility. You can then look at their fee schedule for the service you are performing (or at the end of the visit) and have the patient pay right then. I have been trying to figure out how I can do this after the first of the year. Is anyone else doing that? My best friend is a psychologist and does so on every patient, so each one pays at the time of service whatever their portion is. She of course has only 5 or so cpt codes to deal with though.

[Guest guest]

Almost, but not quite right. Medicare sets a fee schedule, lets say $54 for a 99213 (and say your fee is $80). Medicare then pays you 80% of the $54 if you are participating, the patient is expected to pay the other 20% of the $54. That is after they have met their deductible. But either way, it is based on CMS fee schedule. If you are non-participating you can charge whatever your fee is, medicare pays 80% of whatever their fee schedule is for non-participating doctors (I think it is less than for participating docs) and you can bill the remainder of your entire fee to the patient.

Back to the question of deductibles, I know many of the commercial carriers are letting people check deductible balances when you (or if) you check eligibility. You can then look at their fee schedule for the service you are performing (or at the end of the visit) and have the patient pay right then. I have been trying to figure out how I can do this after the first of the year. Is anyone else doing that? My best friend is a psychologist and does so on every patient, so each one pays at the time of service whatever their portion is. She of course has only 5 or so cpt codes to deal with though.

[Guest guest]

That

is exactly what I thought too, but one recent potential patient swears previous

docs have never billed her for anything above what Medicare paid them. As

a related aside, at least one local doc apparently asks Medicare patients to

pay his full charge upfront for the first appointment of the year since he

thinks it will otherwise just be applied to their deductible & he will then

have to bill them later. That too sounds illegal to me. How does he

know that he is the patient’s first doctor visit for the year?

Medicare co-pay & deductible

For those on the list that still

accept Medicare: does anyone write off that 20% or the annual deductible that

the patient is responsible for? We still get patients that expect us to

just accept the 80% that Medicare pays as payment in full, which blows my

mind. They say that there are docs out there that do that. Is that

true? That is business suicide, if so. I doubt anyone on this list

does this, but I’m just curious how common the practice is.

[Guest guest]

One has to sign up as a “non-participating”

provider with Medicare in order to collect the balance of the fee from them,

correct? Otherwise, you “accept assignment”, and cannot bill

the patient for the remainder of the fee. At least, this is my

understanding.

In order to be “non-par”, the

provider has to collect the fee from the patient and then submit claim to

Medicare so patient can get re-imbursed…or can “accept assignment”

on an individual basis and have Medicare pay you directly and NOT collect

remainder from the patient. If you are “participating”, you

simply accept whatever Medicare pays you and never bill the patient at all.

I sure hope I have this right, b/c I

finally thought I understood all of this!

Ramona

From: [mailto: ] On Behalf Of Brady, MD

Sent: Tuesday, November 14, 2006

2:43 PM

To:

Subject: RE:

Medicare co-pay & deductible

My understanding is that it is illegal to write off the co-pay or

the deductible (unless you are Medicaid). The thinking goes like this… if

you are willing to accept 80% of the allowable then technically you are billing

Medicare 20% more than what you are willing to accept (which Medicare

interprets as insurance fraud). So, by doing a simple act of kindness, you

actually set yourself up for a lawsuit. Yes, exceptions can be made, but it has

to be clear that these patients are the exceptions are not the rule.

-----Original

Message-----

From:

[mailto: ]

On Behalf Of Brock DO

Sent: Tuesday, November 14, 2006

1:52 PM

To:

Subject:

Medicare co-pay & deductible

For those on

the list that still accept Medicare: does anyone write off that 20% or the

annual deductible that the patient is responsible for? We still get

patients that expect us to just accept the 80% that Medicare pays as payment in

full, which blows my mind. They say that there are docs out there that do

that. Is that true? That is business suicide, if so. I doubt

anyone on this list does this, but I’m just curious how common the

practice is.

[Guest guest]

One has to sign up as a “non-participating”

provider with Medicare in order to collect the balance of the fee from them,

correct? Otherwise, you “accept assignment”, and cannot bill

the patient for the remainder of the fee. At least, this is my

understanding.

In order to be “non-par”, the

provider has to collect the fee from the patient and then submit claim to

Medicare so patient can get re-imbursed…or can “accept assignment”

on an individual basis and have Medicare pay you directly and NOT collect

remainder from the patient. If you are “participating”, you

simply accept whatever Medicare pays you and never bill the patient at all.

I sure hope I have this right, b/c I

finally thought I understood all of this!

Ramona

From: [mailto: ] On Behalf Of Brady, MD

Sent: Tuesday, November 14, 2006

2:43 PM

To:

Subject: RE:

Medicare co-pay & deductible

My understanding is that it is illegal to write off the co-pay or

the deductible (unless you are Medicaid). The thinking goes like this… if

you are willing to accept 80% of the allowable then technically you are billing

Medicare 20% more than what you are willing to accept (which Medicare

interprets as insurance fraud). So, by doing a simple act of kindness, you

actually set yourself up for a lawsuit. Yes, exceptions can be made, but it has

to be clear that these patients are the exceptions are not the rule.

-----Original

Message-----

From:

[mailto: ]

On Behalf Of Brock DO

Sent: Tuesday, November 14, 2006

1:52 PM

To:

Subject:

Medicare co-pay & deductible

For those on

the list that still accept Medicare: does anyone write off that 20% or the

annual deductible that the patient is responsible for? We still get

patients that expect us to just accept the 80% that Medicare pays as payment in

full, which blows my mind. They say that there are docs out there that do

that. Is that true? That is business suicide, if so. I doubt

anyone on this list does this, but I’m just curious how common the

practice is.

[Guest guest]

I’m not certain that it would be illegal, but I would guess that system

would be highly inefficient. After all, after Medicare gets through with adding

stuff to their deductible, the secondary has to add it to theirs, and only then

do you know how much a patient owes. For some of my patients, the entire

deductible is paid by the secondary, for others none is paid. I have no idea

unless I had billed them last year (and they have not changed insurances). Even

then, things change. Yes, it is a very frustrating system where it can take

months to get reimbursed, but I would argue taking the patient’s money up

front and then having to reimburse patients later would be even worse.

Medicare co-pay & deductible

For those on the list that still accept Medicare: does

anyone write off that 20% or the annual deductible that the patient is

responsible for? We still get patients that expect us to just accept the

80% that Medicare pays as payment in full, which blows my mind. They say

that there are docs out there that do that. Is that true? That is

business suicide, if so. I doubt anyone on this list does this, but I’m

just curious how common the practice is.

[Guest guest]

I’m not certain that it would be illegal, but I would guess that system

would be highly inefficient. After all, after Medicare gets through with adding

stuff to their deductible, the secondary has to add it to theirs, and only then

do you know how much a patient owes. For some of my patients, the entire

deductible is paid by the secondary, for others none is paid. I have no idea

unless I had billed them last year (and they have not changed insurances). Even

then, things change. Yes, it is a very frustrating system where it can take

months to get reimbursed, but I would argue taking the patient’s money up

front and then having to reimburse patients later would be even worse.

Medicare co-pay & deductible

For those on the list that still accept Medicare: does

anyone write off that 20% or the annual deductible that the patient is

responsible for? We still get patients that expect us to just accept the

80% that Medicare pays as payment in full, which blows my mind. They say

that there are docs out there that do that. Is that true? That is

business suicide, if so. I doubt anyone on this list does this, but I’m

just curious how common the practice is.

[Guest guest]

Have no idea if it's legal or not (I'd bet not...), but you may know the

saying, " A bird in hand is better than two in the bush. " I guess one

could say, " Interest in the bank is better than payment later " ... I know

it doesn't quite work, but the point is, that doc has the cash and pays

bills or accrues interest with it before paying back the patients, and

financially that'll be better for him than just waiting months for payment

without any interest accruing.

Tim

PS -- ... I got it... a better saying for this... " I'd gladly pay you on

Tuesday for a hamburger today! " made famous by Wimpy in Popeye... and just

for the fun of it, here's a comic of that doctor, uh, I mean Wimpy, saying

just that in the Oct 1, 2006 cartoon ... enjoy!...

http://www.kingfeatures.com/features/comics/popeye/about.htm

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original

message, including attachments.

> I'm not certain that it would be illegal, but I would guess that system

> would be highly inefficient. After all, after Medicare gets through with

> adding stuff to their deductible, the secondary has to add it to theirs,

> and only then do you know how much a patient owes. For some of my

> patients, the entire deductible is paid by the secondary, for others

> none is paid. I have no idea unless I had billed them last year (and

> they have not changed insurances). Even then, things change. Yes, it is

> a very frustrating system where it can take months to get reimbursed,

> but I would argue taking the patient's money up front and then having to

> reimburse patients later would be even worse.

>

>

> Medicare co-pay & deductible

>

> For those on the list that still accept Medicare: does anyone write off

> that 20% or the annual deductible that the patient is responsible for?

> We still get patients that expect us to just accept the 80% that

> Medicare pays as payment in full, which blows my mind. They say that

> there are docs out there that do that. Is that true? That is business

> suicide, if so. I doubt anyone on this list does this, but I'm just

> curious how common the practice is.

>

>

>

[Guest guest]

Have no idea if it's legal or not (I'd bet not...), but you may know the

saying, " A bird in hand is better than two in the bush. " I guess one

could say, " Interest in the bank is better than payment later " ... I know

it doesn't quite work, but the point is, that doc has the cash and pays

bills or accrues interest with it before paying back the patients, and

financially that'll be better for him than just waiting months for payment

without any interest accruing.

Tim

PS -- ... I got it... a better saying for this... " I'd gladly pay you on

Tuesday for a hamburger today! " made famous by Wimpy in Popeye... and just

for the fun of it, here's a comic of that doctor, uh, I mean Wimpy, saying

just that in the Oct 1, 2006 cartoon ... enjoy!...

http://www.kingfeatures.com/features/comics/popeye/about.htm

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original

message, including attachments.

> I'm not certain that it would be illegal, but I would guess that system

> would be highly inefficient. After all, after Medicare gets through with

> adding stuff to their deductible, the secondary has to add it to theirs,

> and only then do you know how much a patient owes. For some of my

> patients, the entire deductible is paid by the secondary, for others

> none is paid. I have no idea unless I had billed them last year (and

> they have not changed insurances). Even then, things change. Yes, it is

> a very frustrating system where it can take months to get reimbursed,

> but I would argue taking the patient's money up front and then having to

> reimburse patients later would be even worse.

>

>

> Medicare co-pay & deductible

>

> For those on the list that still accept Medicare: does anyone write off

> that 20% or the annual deductible that the patient is responsible for?

> We still get patients that expect us to just accept the 80% that

> Medicare pays as payment in full, which blows my mind. They say that

> there are docs out there that do that. Is that true? That is business

> suicide, if so. I doubt anyone on this list does this, but I'm just

> curious how common the practice is.

>

>

>

[Guest guest]

I’m

not defending the system at all, as I agree entirely with Larry, but I think

your assumption is wrong. How much interest do you make on one month of say

$100? How much time will it take his office manager (because I bet the doc doesn’t

do the billing) to figure out how much to pay back all these patients three

months down the road? Do you have to hire someone to do this task? What about

the patients? How many get fed up with this process (What?! I have to pay you $115

up front?! But I have Medicare!!) and leave the office.

So yes, initially you may get more money which is great for the first quarter

of the year, but I think you also push up the overhead and decrease patient

satisfaction which would end up costing much more.

Medicare co-pay & deductible

>

> For those on the list that still accept Medicare: does anyone write off

> that 20% or the annual deductible that the patient is responsible for?

> We still get patients that expect us to just accept the 80% that

> Medicare pays as payment in full, which blows my mind. They say that

> there are docs out there that do that. Is that true? That is business

> suicide, if so. I doubt anyone on this list does this, but I'm just

> curious how common the practice is.

>

>

>

[Guest guest]

I write it off on all my medicare as primary, medicaid as secondary payors,

since medicaid pays $0 to me on those claims. Another civic duty millstone

hanging around my neck. Everyone else with secondary insurance or no

secondary insurance I charge.

Lynn

>

>Reply-To:

>To: < >

>Subject: Medicare co-pay & deductible

>Date: Tue, 14 Nov 2006 13:51:42 -0500

>

>For those on the list that still accept Medicare: does anyone write off

>that

>20% or the annual deductible that the patient is responsible for? We still

>get patients that expect us to just accept the 80% that Medicare pays as

>payment in full, which blows my mind. They say that there are docs out

>there that do that. Is that true? That is business suicide, if so. I

>doubt anyone on this list does this, but I'm just curious how common the

>practice is.

>

>

>

>

>

_________________________________________________________________

Find a local pizza place, music store, museum and more…then map the best

route! http://local.live.com?FORM=MGA001

[Guest guest]

I write it off on all my medicare as primary, medicaid as secondary payors,

since medicaid pays $0 to me on those claims. Another civic duty millstone

hanging around my neck. Everyone else with secondary insurance or no

secondary insurance I charge.

Lynn

>

>Reply-To:

>To: < >

>Subject: Medicare co-pay & deductible

>Date: Tue, 14 Nov 2006 13:51:42 -0500

>

>For those on the list that still accept Medicare: does anyone write off

>that

>20% or the annual deductible that the patient is responsible for? We still

>get patients that expect us to just accept the 80% that Medicare pays as

>payment in full, which blows my mind. They say that there are docs out

>there that do that. Is that true? That is business suicide, if so. I

>doubt anyone on this list does this, but I'm just curious how common the

>practice is.

>

>

>

>

>

_________________________________________________________________

Find a local pizza place, music store, museum and more…then map the best

route! http://local.live.com?FORM=MGA001

[Guest guest]

As a pediatrician, the only thing I know about this issue is what

happens with my dad's bills. He has part B insurance through his

previous employer (for which he pays monthly). That part B pays 80%

of the 20% not covered by Medicare and he pays the rest. This occurs

whether it is an X-ray, a procedure in an outpatient surgicenter, or

his physician or a specialist. In otherwords, he is responsible for

only 4% of the bill (20% x 20%) It is clearly not illegal to bill the

patient for the remaining 20%--isn't that partly why Medicare part B

exists?? The hospitals bill him after both Medicare and the insurance

company pays. I am guessing that with Medicare patients you have to

accept the Medicare fee schedule but can certainly bill up to that fee

schedule.

>

> Almost, but not quite right. Medicare sets a fee schedule, lets say

$54 for

> a 99213 (and say your fee is $80). Medicare then pays you 80% of

the $54 if

> you are participating, the patient is expected to pay the other 20%

of the

> $54. That is after they have met their deductible. But either way,

it is

> based on CMS fee schedule. If you are non-participating you can

charge whatever

> your fee is, medicare pays 80% of whatever their fee schedule is for

> non-participating doctors (I think it is less than for participating

docs) and you

> can bill the remainder of your entire fee to the patient.

>

> Back to the question of deductibles, I know many of the commercial

carriers

> are letting people check deductible balances when you (or if) you

check

> eligibility. You can then look at their fee schedule for the service

you are

> performing (or at the end of the visit) and have the patient pay

right then. I

> have been trying to figure out how I can do this after the first of

the year.

> Is anyone else doing that? My best friend is a psychologist and

does so on

> every patient, so each one pays at the time of service whatever

their portion

> is. She of course has only 5 or so cpt codes to deal with though.

>

>

>

[Guest guest]

As a pediatrician, the only thing I know about this issue is what

happens with my dad's bills. He has part B insurance through his

previous employer (for which he pays monthly). That part B pays 80%

of the 20% not covered by Medicare and he pays the rest. This occurs

whether it is an X-ray, a procedure in an outpatient surgicenter, or

his physician or a specialist. In otherwords, he is responsible for

only 4% of the bill (20% x 20%) It is clearly not illegal to bill the

patient for the remaining 20%--isn't that partly why Medicare part B

exists?? The hospitals bill him after both Medicare and the insurance

company pays. I am guessing that with Medicare patients you have to

accept the Medicare fee schedule but can certainly bill up to that fee

schedule.

>

> Almost, but not quite right. Medicare sets a fee schedule, lets say

$54 for

> a 99213 (and say your fee is $80). Medicare then pays you 80% of

the $54 if

> you are participating, the patient is expected to pay the other 20%

of the

> $54. That is after they have met their deductible. But either way,

it is

> based on CMS fee schedule. If you are non-participating you can

charge whatever

> your fee is, medicare pays 80% of whatever their fee schedule is for

> non-participating doctors (I think it is less than for participating

docs) and you

> can bill the remainder of your entire fee to the patient.

>

> Back to the question of deductibles, I know many of the commercial

carriers

> are letting people check deductible balances when you (or if) you

check

> eligibility. You can then look at their fee schedule for the service

you are

> performing (or at the end of the visit) and have the patient pay

right then. I

> have been trying to figure out how I can do this after the first of

the year.

> Is anyone else doing that? My best friend is a psychologist and

does so on

> every patient, so each one pays at the time of service whatever

their portion

> is. She of course has only 5 or so cpt codes to deal with though.

>

>

>

[Guest guest]

has it right

Once you are par with Medicare, you are accepting their fee schedule. However, Medicare only pays 80% of that fee schedule and you absolutely get the rest. It may come from a secondary plan or directly from the patient, if they don't have a supplementary plan. For example, here in our region of Michigan for a 99214, Medicare approves $80.51. They pay us 80%, which is $64.41. We then collect $16.10 from secondary insurance or from the patient (if they have no secondary), or a combination of both, depending on their secondary coverage. I do our billing and actually, Medicare and secondary billing for Medicare are the claims with the least hassles for us. We do not participate with Medicaid.

The annual Medicare deductible at the beginning of the year is a problem because we bill the patient after getting the Medicare eob back and we are reliant on patients paying promptly. As strapped as our patients are, though, most seniors are very conscientious about paying their deductible amount fairly soon after getting a bill from us.

a Mintek

Downtown Allegan Family Practice

Re: Medicare co-pay & deductible

Almost, but not quite right. Medicare sets a fee schedule, lets say $54 for a 99213 (and say your fee is $80). Medicare then pays you 80% of the $54 if you are participating, the patient is expected to pay the other 20% of the $54. That is after they have met their deductible. But either way, it is based on CMS fee schedule. If you are non-participating you can charge whatever your fee is, medicare pays 80% of whatever their fee schedule is for non-participating doctors (I think it is less than for participating docs) and you can bill the remainder of your entire fee to the patient.

Back to the question of deductibles, I know many of the commercial carriers are letting people check deductible balances when you (or if) you check eligibility. You can then look at their fee schedule for the service you are performing (or at the end of the visit) and have the patient pay right then. I have been trying to figure out how I can do this after the first of the year. Is anyone else doing that? My best friend is a psychologist and does so on every patient, so each one pays at the time of service whatever their portion is. She of course has only 5 or so cpt codes to deal with though.

[Guest guest]

has it right

Once you are par with Medicare, you are accepting their fee schedule. However, Medicare only pays 80% of that fee schedule and you absolutely get the rest. It may come from a secondary plan or directly from the patient, if they don't have a supplementary plan. For example, here in our region of Michigan for a 99214, Medicare approves $80.51. They pay us 80%, which is $64.41. We then collect $16.10 from secondary insurance or from the patient (if they have no secondary), or a combination of both, depending on their secondary coverage. I do our billing and actually, Medicare and secondary billing for Medicare are the claims with the least hassles for us. We do not participate with Medicaid.

The annual Medicare deductible at the beginning of the year is a problem because we bill the patient after getting the Medicare eob back and we are reliant on patients paying promptly. As strapped as our patients are, though, most seniors are very conscientious about paying their deductible amount fairly soon after getting a bill from us.

a Mintek

Downtown Allegan Family Practice

Re: Medicare co-pay & deductible

Almost, but not quite right. Medicare sets a fee schedule, lets say $54 for a 99213 (and say your fee is $80). Medicare then pays you 80% of the $54 if you are participating, the patient is expected to pay the other 20% of the $54. That is after they have met their deductible. But either way, it is based on CMS fee schedule. If you are non-participating you can charge whatever your fee is, medicare pays 80% of whatever their fee schedule is for non-participating doctors (I think it is less than for participating docs) and you can bill the remainder of your entire fee to the patient.

Back to the question of deductibles, I know many of the commercial carriers are letting people check deductible balances when you (or if) you check eligibility. You can then look at their fee schedule for the service you are performing (or at the end of the visit) and have the patient pay right then. I have been trying to figure out how I can do this after the first of the year. Is anyone else doing that? My best friend is a psychologist and does so on every patient, so each one pays at the time of service whatever their portion is. She of course has only 5 or so cpt codes to deal with though.

[Guest guest]

I don’t

think that’s quite correct. If you participate, Medicare will allow you

charge the full amount, say $54, and they will pay 80% of that. After the

patient pays their 20% ($10.80), and the government their 80%, you end up

getting paid $54. If you are non-participating. Medicare allows you to charge

up to a Limiting Charge, which is 115% of the non-participating allowed fee

(which is 95% of the participating fee and is also. 9.25% above the Medicare

Participating Allowed fee). Thus in this example, it would be $58.99. The

downside of being non-participating, is that Medicare pays 5% less, i.e. 80% of

$51.30 or $41.04, and the patient has to pay the rest ($17.95). (See http://www.medicalmanagement.com/aac/aac011220-1.htm

for a summary of this and a calculator.)

If you accept Medicare assignment, you agree

to accept the allowable charge that Medicare sets as the full payment, and to accept

assignment on all Medicare claims. Medicare makes payments directly to the

physician.

A non-participating physician may decide

on a claim to claim basis whether to accept assignment. If they do not accept assignment,

they can make 9.25% more, as noted above, but the patient pays a bigger

portion. What’s more, Medicare makes payments to the beneficiary

(patient) and the physician is responsible to collect the entire fee from the

patient. If you are a participating or non-participating physician, you must

submit the paperwork on behalf of the patient.

The only way to be able to charge Medicare

patients what ever you want is to be a private contractor. The problem is that

you and your patient must forgo all Medicare reimbursement for each visit,

making the patient responsible for all charges, and you have to opt out for 2

years (and file an affidavit at least 30 days before the beginning of a

calendar quarter).

Dan

Re:

Medicare co-pay & deductible

Almost, but not quite right. Medicare

sets a fee schedule, lets say $54 for a 99213 (and say your fee is $80).

Medicare then pays you 80% of the $54 if you are participating, the patient is

expected to pay the other 20% of the $54. That is after they have met

their deductible. But either way, it is based on CMS fee schedule.

If you are non-participating you can charge whatever your fee is, medicare pays

80% of whatever their fee schedule is for non-participating doctors (I think it

is less than for participating docs) and you can bill the remainder of your

entire fee to the patient.

[Guest guest]

I don’t

think that’s quite correct. If you participate, Medicare will allow you

charge the full amount, say $54, and they will pay 80% of that. After the

patient pays their 20% ($10.80), and the government their 80%, you end up

getting paid $54. If you are non-participating. Medicare allows you to charge

up to a Limiting Charge, which is 115% of the non-participating allowed fee

(which is 95% of the participating fee and is also. 9.25% above the Medicare

Participating Allowed fee). Thus in this example, it would be $58.99. The

downside of being non-participating, is that Medicare pays 5% less, i.e. 80% of

$51.30 or $41.04, and the patient has to pay the rest ($17.95). (See http://www.medicalmanagement.com/aac/aac011220-1.htm

for a summary of this and a calculator.)

If you accept Medicare assignment, you agree

to accept the allowable charge that Medicare sets as the full payment, and to accept

assignment on all Medicare claims. Medicare makes payments directly to the

physician.

A non-participating physician may decide

on a claim to claim basis whether to accept assignment. If they do not accept assignment,

they can make 9.25% more, as noted above, but the patient pays a bigger

portion. What’s more, Medicare makes payments to the beneficiary

(patient) and the physician is responsible to collect the entire fee from the

patient. If you are a participating or non-participating physician, you must

submit the paperwork on behalf of the patient.

The only way to be able to charge Medicare

patients what ever you want is to be a private contractor. The problem is that

you and your patient must forgo all Medicare reimbursement for each visit,

making the patient responsible for all charges, and you have to opt out for 2

years (and file an affidavit at least 30 days before the beginning of a

calendar quarter).

Dan

Re:

Medicare co-pay & deductible

Almost, but not quite right. Medicare

sets a fee schedule, lets say $54 for a 99213 (and say your fee is $80).

Medicare then pays you 80% of the $54 if you are participating, the patient is

expected to pay the other 20% of the $54. That is after they have met

their deductible. But either way, it is based on CMS fee schedule.

If you are non-participating you can charge whatever your fee is, medicare pays

80% of whatever their fee schedule is for non-participating doctors (I think it

is less than for participating docs) and you can bill the remainder of your

entire fee to the patient.

[Guest guest]

I

certainly expect to be paid by the patients for their “patient

responsibility” portions, and so far as I can find out, the same is true

in all the practices in Lexington. When I hear from

patients that they are accustomed to NOT paying, it always turns out that it

was “Ole Doc So’n’so” who

just retired/died/had a heart attack, so he can’t keep seeing the 80

patients per day he was seeing out in the wilderness somewhere.

Incidentally, today I spoke with a

hospital employee who runs the physician finder service and who told me that

she has no primary care doctors at all to whom she can send Medicaid patients,

and gets 25 to 50 calls per week from Medicare beneficiaries who say they can’t

find a doctor who will take new Medicare patients, and she only knows two primary

care docs to send them to….scary! ( I told

her I would take a few, but not to go crazy)

Annie

Medicare co-pay & deductible

For those on the list that still accept Medicare: does

anyone write off that 20% or the annual deductible that the patient is

responsible for? We still get patients that expect us to just accept the

80% that Medicare pays as payment in full, which blows my mind. They say

that there are docs out there that do that. Is that true? That is

business suicide, if so. I doubt anyone on this list does this, but

I’m just curious how common the practice is.