Author Topic: Medicare Bad Debt  (Read 1974 times)

mandibrown74

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Medicare Bad Debt
« on: January 20, 2014, 01:34:47 PM »
I am in need of clarification!!!  This is the scenario for outpatient CMHC claims:  When writing off a patient balance to bad debt, my current protocol is this:  Bill claim to Medicare, receive payment from Medicare, claim will then cross over to secondary, if applicable.  Once payment from primary and secondary (if applicable) is received, balance is then billed to patient.  Statement for balance due then sent to patient.  When Exhibit 5 is completed, the date the first invoice/statement is sent to patient is recorded as well as all payment dates.  120 day requirement begins with 1st patient invoice/statement date, unless subsequent payment(s) are received, at which 120 day requirement starts again with most recent payment date. 
However, I am being told that Medicare Guidelines state first invoice is to be sent to patient upon discharge, regardless of when the first claim was submitted for reimbursement.  Now, for those who bill for CMHC claims, it is not unlikely to have a patient with an admission date and discharge date with a 6 month interval.  So, based upon the information that I am being provided, the invoice for the 1st claim does not have to be sent until the patient is discharged.  This does not make any sense to me and I would love to get some feedback!

Merry

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Re: Medicare Bad Debt
« Reply #1 on: January 21, 2014, 03:00:33 PM »
I would love to help you. I am not familiar with Medicare guidelines for CMHC's though I know what they are. I Googled as soon as I saw your post but so much material online is over 2 years old so I am not sure what info to give you. Better for me to not post than to give out the incorrect information. Please though update us when you find out.

Merry

mandibrown74

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Re: Medicare Bad Debt
« Reply #2 on: January 21, 2014, 03:02:33 PM »
I appreciate your attempts!  Thank you and once I am able to obtain additional information, I will then post that information.  Thank you again for trying.

Merry

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Re: Medicare Bad Debt
« Reply #3 on: January 21, 2014, 09:59:49 PM »
Thank you for sharing. I am sure your billing is unique.

PMRNC

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Re: Medicare Bad Debt
« Reply #4 on: January 22, 2014, 09:58:05 AM »
Quote
I am being told that Medicare Guidelines state first invoice is to be sent to patient upon discharge, regardless of when the first claim was submitted for reimbursement.  Now, for those who bill for CMHC claims, it is not unlikely to have a patient with an admission date and discharge date with a 6 month interval

Do you know where you got that info? I'm not thinking that is absolutely incorrect. "First CMHC is required to be Furnished under an individualized
plan of treatment that is periodically reviewed and meets the requirements of 42 CFR 424.24(e)(2). "  The keyword being "INDIVIDUALIZED"  With that said I think it's IMPOSSIBLE to bill the beneficiary before the treatment plan is discharged NOT just the discharge date. Many times patients are in and out of the CMHC. I know that claims over 147 days will be scrutinized but there is no written limited amount of days, again, because of the necessity to establish individual plans of treatment"   I'd want to see where you got this info .. it doesn't sound correct at all.
« Last Edit: January 22, 2014, 11:55:35 AM by PMRNC »
Linda Walker
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Michele

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Re: Medicare Bad Debt
« Reply #5 on: January 22, 2014, 09:59:07 AM »
I agree with Linda.  It doesn't sound correct.  I've been trying to find info about it and I'm not able to. 
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Merry

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Re: Medicare Bad Debt
« Reply #6 on: January 22, 2014, 09:12:36 PM »
You have certainly posted a question that has stumped us all.