medicare part b

[rdmoore2003]

In our state over the last few months, our state medicaid program has contracted out with Magellan.   We have since cancelled our contract with medicaid and have chosen not to contract with magellan.   We are in a state that is considered to not have enough outreaches to medical/dental/mental health etc. We are mental health.  We are contracted with Medicare.  We see alot of medicare patients that have medicaid as secondary.  With these patients, they are mostly pain management patients and those on social security/disability.  My question is, Is there a form with medicare that our patients can sign to waive their copays if documentation is in their chart showing the medical necessity of the therapy and documentation showing their income level that they cannot afford the medicare copays on a weekly basis?

[PMRNC]

No, there is not. Your client's office MUST have a policy in place with provisions for financial hardship and what their office considers to be a financial hardship. A provider cannot pick and choose who he waives out of pocket for. That is why it is absolutely required to have an office policy and policies and procedures that CLEARLY define and document these things so there are no grey areas. This is a question that would be answered by opening up  the P&P and the policies and procedures that define a financial hardship.  99.9% of questions are answered in there and if there is none, that's big trouble.   Every practice may define their own financial hardships, for example, I have one client who used to have a bleeding heart until he almost faced bankruptcy.. then we developed a strict office policy and procedures for him that let HIM off the hook. In his questionnaire he has the patient fill out to establish financial hardship some of the questions were: Do you have a computer? Do you have internet access? Do you have Cable TV?  Many patients ask why and it's very simple, a physician is in business too.. if someone can afford to have HBO, and internet access, surely they could afford the $10 or $20 copay.  I also have clients with a simpler approach and just want to know income level vs. Expenses. I have clients also that do NOT waive co payments PERIOD.. they will consider financial hardships on large balances or non covered, but again they have defined a criteria for that.   

[rdmoore2003]

yes I understand.  because of the changes from medicaid to magellan.  providers in our area are having to relook at our policies.  my provider is wanting to waive the medicare copays, ($31.76 for 90806) to those patients that only had medicaid secondary.  provider is wanting to have patients show their proof of income that cannot be more than $1500.00 per month.  Is this helpful?

[PMRNC]

Yes, he can set the criteria for his office, as long as it's documented AND each patient he does that for is documented in their file to be a hardship case.  When it becomes fraud is when he does it routinely.. in other words, he cannot choose to waive those copay's for all his Medicare/Magellan patient's, that would be "abuse"  each case has to be reviewed independently on a case-by-case basis, meet the documented policy of hardship for that practice and then documented in the patient's file.   If he doesn't all it takes is for one patient to talk to another patient and he could be in trouble... and that happens a LOT with mental health providers because they seem to be the ones with the bleeding hearts.