Can provider collect Medicare deductible upfront?

Yes, we could collect the payment but it has to be refunded promptly if you are collecting excess payment or collected incorrectly. See the below what says in Medicare contract.

Yes its a good practice too improve patient payment collection.



 Provider Refunds to Beneficiaries 

In the agreement between CMS and a provider, the provider agrees to refund as promptly as possible any money incorrectly collected from Medicare beneficiaries or from someone on their behalf.

Money incorrectly collected means any amount for covered services that is greater than the amount for which the beneficiary is liable because of the deductible and coinsurance requirements.

Amounts are considered to have been incorrectly collected because the provider believed the beneficiary was not entitled to Medicare benefits but:

• The beneficiary was later determined to have been entitled to Medicare benefits;

• The beneficiary’s entitlement period fell within the time the provider’s agreement with CMS was in effect; and

• Such amounts exceed the beneficiary’s deductible, coinsurance or non covered services liability.

collect

Requiring Prepayment as a Condition of Admission is Prohibited

Providers must not require advance payment of the inpatient deductible or coinsurance as a condition of admission. Additionally, providers may not require that the beneficiary prepay any Part B charges as a condition of admission, except where prepayment from  non-Medicare patients is required. In such cases, only the deductible and coinsurance may be collected.

When Prepayment May Be Requested

he provider may collect deductible or coinsurance amounts only where it appears that the patient will owe deductible or coinsurance amounts and where it is routine and
customary policy to request similar prepayment from non-Medicare patients with similar benefits that leave patients responsible for a part of the cost of their hospital services. In  admitting or registering patients, the provider must ascertain whether beneficiaries have medical insurance coverage. Where beneficiaries have medical insurance coverage, the provider asks the beneficiary if he/she has a Medicare Summary Notice (MSN) showing his/her deductible status. If a beneficiary shows that the Part B deductible is met, the provider will not request or require prepayment of the deductible.

Except in rare cases where prepayment may be required, any request for payment must be made as a request and without undue pressure. The beneficiary (and the beneficiary’s family) must not be given cause to fear that admission or treatment will be denied for failure to make the advance payment.

Providers must insure that the admitting office personnel are informed and kept fully aware of the policy on prepayment. For this purpose, and for the benefit of the provider and the public, it is desirable that a notice be posted prominently in the admitting office or lobby to the effect that no patient will be refused admission for inability to make an advance payment or deposit if Medicare is expected to pay the hospital costs.


Guide for Patient


What you pay

For most services, you (or your supplemental coverage) pay the following:

The yearly Part B deductible if you haven’t already paid it for the year.

A copayment amount for each service you get in an outpatient visit. For each service, this amount generally can’t be more than the Part A inpatient hospital
deductible. If you get hospital outpatient services in a critical access hospital, your copayment may be higher and may exceed the Part A hospital stay deductible.
All charges for items or services that Medicare doesn’t cover.

Example: Mr. Davis needs to have his cast removed. He goes to his local hospital outpatient department. The hospital charges $150 for this procedure. His copayment amount for this procedure, under the outpatient prospective payment system, is $20. Mr. Davis has paid $85 of his $155 Part B deductible. To have his cast removed, Mr. Davis must pay $90 ($70 remaining deductible amount + $20 copayment amount).

The amount you pay may change each year. The amount you pay may also be different for different hospitals.

Note: If you have a Medigap (Medicare Supplement Insurance) policy, other supplemental coverage, or employer or union coverage, it may pay the Part B deductible and copayment amounts.


If you paid more than the amount listed on your Medicare Summary Notice

After Medicare gets a bill from the hospital, you will get a Medicare Summary Notice. This notice will show how much you have to pay for the services you got. It will also show how much Medicare paid the hospital for the services. If the amount you paid the hospital or community mental health center at the time of service is more than what was listed on the Medicare Summary Notice, call the provider and ask for a refund. Tell them you paid more than the amount listed on the Medicare Summary Notice.

If you paid less than the amount listed on your Medicare Summary Notice

If you paid less than the amount listed on your Medicare Summary Notice, the hospital or community mental health center may bill you for the difference if you don’t have another insurer who is responsible for paying your deductible and copayments.

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