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Medicare rules on blg pts for copays/ded

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Michele:
Sorry Linda!  I can tell this is one of your pet peeves!  I didn't mean to get you all riled up.  I was assuming (which as I type it I realize I shouldn't assume) that good faith effort was made, but then the patient contacted the office claiming a financial hardship, and what specific documentation would be required to remain compliant.  Not to give them a life time pass.  Anyway the info you gave is great and I'm sure that will help.

Thanks
Michele

PMRNC:

--- Quote ---Sorry Linda!  I can tell this is one of your pet peeves!  I didn't mean to get you all riled up.  I was assuming (which as I type it I realize I shouldn't assume) that good faith effort was made, but then the patient contacted the office claiming a financial hardship, and what specific documentation would be required to remain compliant.  Not to give them a life time pass.  Anyway the info you gave is great and I'm sure that will help.
--- End quote ---

No ONE riled me up.. aside from the consistent flow of doctors who want you to "SHOW them" something that is so utterly clear, they WANT a loophole.   I didn't get that this was for a particular case of hardship, as this was the original post:


--- Quote ---I am looking for a written summary by Medicare on their guidelines for writing off patient copays and deductibles.  I found your article but know the doctor is going to want it right out of the Medicare guide.  I looked through a couple of websites but cannot find the documentation I am looking for.  Any ideas where I find it?
--- End quote ---

ONCE a patient is seen, a claim was processed and there was a reasonable attempt to collect the OOP, if a patient contacts the office, the proper way to handle it is to have the provider pull the signed copy of the office policy given to the patient at the time of their visit, in there it should describe financial policy.. for example, some will state to merely call the office to make payment arrangements. In every doctors office there should also be a compliance plan and a financial policy that they adhere to for EVERYONE to keep things fair and in accordance with all rules/regulations. If the policy of the office is to first make payment arrangements that's what they do. If their policy is to give an additional 90 days, that's what they do, if their policy is to have the patient complete a hardship agreement or even application (I have a client who has indigent/hardship patients complete an application in which he approves or not) then they have the patient complete/sign.

BEFORE the claim is sent, IF the provider is going to "waive" OOP he/she MUST report that on the claim. If you are going to discount the patient, you have to discount the carrier,and it's not just Medicare, it's also illegal to waive OOP for patients with "cost sharing" policies, it's in their policy booklet.

Pay_My_Claims:
yes documentation is the key because for hospitals that have huge w/o for Medicare patients, the government will pay them a portion of the money they lost.

PMRNC:
I'm no tax expert and I certainly am no accountant but this sort of leads me to a question about that.. maybe someone knows. can doctors write off bad debt on their taxes?  I'm just curious!

jcbilling:
I have another question that is somewhat related....I have a client that wants to know if she can write off a balance of under $5.00 rather than sending a statement. Recently, I sent a statement for $2.17 - It was the patient responsisbility from Aetna. Is that still wrong?

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