Medicare Deductibles
Like most insurance plans, Medicare Parts A & B have deductibles, applicable to covered services and supplies, that must be satisfied before the carrier or intermediary pays.
Physicians must collect the unmet deductible from the beneficiary. Consistently waiving the deducti- ble may be interpreted as program abuse. If a beneficiary is unable to pay the deductible, the physi- cian should ask him or her to sign a waiver that explains the financial hardship. If no waiver is signed, the beneficiary ’ s medical record should reflect normal and reasonable attempts to collect, before the charge is written off.
Medicare Coinsurance
Coinsurance is the amount that Medicare will not pay; the beneficiary or the beneficiary ’ s supple- mental insurance company is responsible for paying coinsurance to the physician.
Coinsurance amounts are generally 20% of the Medicare fee schedule. Physicians must collect the unmet coinsurance from the beneficiary. Consistently waiving the coinsurance may be interpreted as program abuse. If a beneficiary is unable to pay the coinsurance, the physician should ask him or herto sign a waiver that explains the financial hardship. If no waiver is signed, the beneficiary ’ s medical record should reflect normal and reasonable attempts to collect, before the charge is written off.
Note : Normal and reasonable means applying normal collection processes to Medicare as well as non-Medicare patients. For example, if a physician normally telephones non-Medicare patients and sends two written notices before writing off charges or referring them to a collection agency, Medi- care patients must receive the same treatment.