• Collecting patient deductibles


    Question: When is it appropriate to collect the deductible/co-insurance from a patient? We have heard that we can no longer collect at the time of the service.

    Answer: In a a recent update, First Coast Medicare Administrative Contractor stated: "Although it's not a violation for participating providers to accept payment prior to rendering services, there are specific guidelines to follow, especially when reporting these payments. Additionally, some providers who accept assignment have a concern that Medicare issues partial checks to beneficiaries. Such checks are generally issued because of a patient paid amount in item 29 of the CMS-1500 (02/12) claim form."

    When assignment is accepted, Medicare Part B recommends:

    • You not collect deductible/coinsurance amounts until Medicare Part B payment is received since it is difficult to predict when these amounts will apply (and over-collection is considered program abuse). In addition, this practice can cause Medicare to issue a portion of the provider's check to beneficiaries on assigned claims.
    • If you believe you can accurately predict the co-insurance amount and wish to collect it before you receive Medicare Part B payment, note the amount collected for co-insurance on your claim form.
    • You not show any amounts collected from patients if the service is never covered by Medicare Part B or you believe, in a particular case, the service will be denied payment. Where patient paid amounts are shown for services that are denied payment, a portion of the provider's check may go to the beneficiary.
    • There is no need to show a patient paid amount in item 29 of form CMS-1500 (or electronic equivalent) when assignment is not accepted.