Author Topic: Medicare co-pay  (Read 1126 times)

Migualla

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Medicare co-pay
« on: October 20, 2009, 09:50:31 AM »
I have a question.  We are a Psychologist office that accepts Medicare insurance.  I am trying to figure out the co pay formula or rules when the patient only has Medicare and no secondary insurance.  Our Billed amount is 130.00, our allowed amount is 89.67, Medicare pays 44.83, are we allowed to charge our patients for the remainder amount that Medicare doesnt pay(44.84)?  Someone told me that we are only allowed to charge 20% of the allowed amount, then someone else said 20% of the charged amount and yet another biller said charge the full amount that Medicare doesnt pay???  Thanks!!

cconter

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Re: Medicare co-pay
« Reply #1 on: October 20, 2009, 10:52:42 AM »
Medicare will designate the "patient responsible" amount on the EOB.  I know we all hate to let the patient leave the office without paying, but you should not be collecting from the patient until the EOB is received from Medicare.  It appears that Medicare's co-insurance rate for psychological services is 50%.  So that is what the patient will be required to pay: 50% of ALLOWED amount.  Difference between billed and Medicare allowed will have to be written off.

PMRNC

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Re: Medicare co-pay
« Reply #2 on: October 20, 2009, 10:56:39 AM »
Agreed  $44.84 is Billable.  Medicare pays mental health 50% of allowed
Linda Walker
Practice Managers Resource & Networking Community
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Migualla

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Re: Medicare co-pay
« Reply #3 on: October 26, 2009, 12:10:53 PM »
Whew, that is what we have been doing so that saves me a ton of headaches..  Thanks for the input!!  I appreciate it so much

Michelle