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Need a Medicare deductibles/copays/coinsurance 101 quick overview please!

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DMK:
JMHO - I keep a list of regularly billed codes, allowed amounts and co-pays.  That way I KNOW exactly what I can collect.

If you know the patient has a secondary or supplemental, check the coverage, then you know if the patient will ever have to be billed for anything.  Better to collect up front, or to tell them up front "Medicare will pay this, and your supplemental will pay that".  And you look like a star when you know your stuff.

Also, our JMAC has a great site that you can look right at the time of service and see if they've met their deductible.  (This year it's $147.00)  I have a few patients with no supplemental so I know what to collect and I can tell them "as of right now, you haven't met your deductible".

kristin:
One thing I will add to the discussion about collecting deductibles upfront, and this is for the OP...if you do decide to do that, you had better be sure you are submitting your claims that same day, and that they are "clean" claims.

I don't collect Medicare deductibles upfront, and every year, I have at least five patients whose deductible we meet, and we bill them, and then they call and say that they already paid their deductible upfront at Dr. So and So's office, so why am I billing them for something they already paid? 

Trying to explain to an elderly patient (who does not understand deductibles in the first place) that Dr. So and So may have taken their money upfront, but my doctor's claim was processed first, and that they need to get their money back from Dr. So and So is not fun for me. Somehow, I end up looking like the bad guy for billing them, and NOT Dr. So and So's office who took money upfront, and didn't submit the claim right away. Argh...

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