RE: Regulation Question

[Guest guest]

I have a client who is contracted with an HMO. When an HMO patient comes in the door that has Medicare as their primary and the HMO product as the secondary insurance, the HMO product is refusing to cover the coinsurance and deductible amounts because Medicare pays more than they would as the primary insurer. They have also told my client they would be in violation of their contract if they billed the patient for the unpaid coinsurance and deductible. Because this HMO has a large population in their treating area, they cannot afford to lose the patient base. I am concerned because my I recall reading or hearing that you cannot waive a Medicare patients coinsurance and deductible amount. To do so indicates that you are overcharging the Medicare program. However, I also do not recall where I heard this and would like to be able to cite the federal regulation (if it in fact exists) in correspondence with the HMO. Anyone out there able to help me out?

Thanks in Advance!

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA 319/447-5625

Visit our Web Page at:

http://members.aol.com/jhall49629

[Guest guest]

I have a client who is contracted with an HMO. When an HMO patient comes in the door that has Medicare as their primary and the HMO product as the secondary insurance, the HMO product is refusing to cover the coinsurance and deductible amounts because Medicare pays more than they would as the primary insurer. They have also told my client they would be in violation of their contract if they billed the patient for the unpaid coinsurance and deductible. Because this HMO has a large population in their treating area, they cannot afford to lose the patient base. I am concerned because my I recall reading or hearing that you cannot waive a Medicare patients coinsurance and deductible amount. To do so indicates that you are overcharging the Medicare program. However, I also do not recall where I heard this and would like to be able to cite the federal regulation (if it in fact exists) in correspondence with the HMO. Anyone out there able to help me out?

Thanks in Advance!

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA 319/447-5625

Visit our Web Page at:

http://members.aol.com/jhall49629

[Guest guest]

I have a client who is contracted with an HMO. When an HMO patient comes in the door that has Medicare as their primary and the HMO product as the secondary insurance, the HMO product is refusing to cover the coinsurance and deductible amounts because Medicare pays more than they would as the primary insurer. They have also told my client they would be in violation of their contract if they billed the patient for the unpaid coinsurance and deductible. Because this HMO has a large population in their treating area, they cannot afford to lose the patient base. I am concerned because my I recall reading or hearing that you cannot waive a Medicare patients coinsurance and deductible amount. To do so indicates that you are overcharging the Medicare program. However, I also do not recall where I heard this and would like to be able to cite the federal regulation (if it in fact exists) in correspondence with the HMO. Anyone out there able to help me out?

Thanks in Advance!

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA 319/447-5625

Visit our Web Page at:

http://members.aol.com/jhall49629

[Guest guest]

Herb;

Thanks for the feedback. However, I am in need of the legal reference. I started with HIM 15I, Section 300 (which Beckley kindly provided reference to a HCFA website for). I will go back an reread this section, but did not come away with a clear picture that this would meet the legal standard that I need for billing the coinsurance and deductibles. This passage addresses what constitutes an allowable bad debt write off (i.e., collection efforts, documentation requirements, etc.). When I read this section, I have a feeling that it is no longer worth quoting, since Allowable Bad Debts were phased out of cost reporting within the last year or so. Once again, if anyone has any references to legislation, let me know.

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA 319/447-5625

Visit our web page at:

http://members.aol.com/jhall49629

[Guest guest]

Herb;

Thanks for the feedback. However, I am in need of the legal reference. I started with HIM 15I, Section 300 (which Beckley kindly provided reference to a HCFA website for). I will go back an reread this section, but did not come away with a clear picture that this would meet the legal standard that I need for billing the coinsurance and deductibles. This passage addresses what constitutes an allowable bad debt write off (i.e., collection efforts, documentation requirements, etc.). When I read this section, I have a feeling that it is no longer worth quoting, since Allowable Bad Debts were phased out of cost reporting within the last year or so. Once again, if anyone has any references to legislation, let me know.

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA 319/447-5625

Visit our web page at:

http://members.aol.com/jhall49629

[Guest guest]

I continue to appreciate the feedback I am receiving on this issue. I have reread the HIM 15I, Section 300 series this morning and feel that I could use it to support my case. However, I am looking for the knockout punch. I am very aware of the arguments, discussions, etc. for collecting coinsurance and deductibles relating to Medicare patients. These points will not hold water with the HMO unless I can steer them to very specific Federal Regulations that tell them what they are asking us to do is in violation of Medicare Regs.

Thanks for the continued feedback!

Jim <///><