PAYMENT POSTING

 Medicare will pay 80% of the RHC encounter rate. 

 The patient/co-insurance will be responsible for 20% of the charge.

MEDICARE SECONDARY PAYER

 Collect patient health insurance or coverage information at EACH patient visit. 

 Tools can be found on the CMS website: 

 http://www.cms.gov/manuals/downloads/msp105c03.pdf 

 Bill the primary payer before billing Medicare, as required by the Social Security Act.

SECONDARY BILLING AFTER MEDICARE

 20% of charges may not be equal to 20% of the encounter rate (if the charges are not equal to the encounter rate) 

 Coinsurance is established on the 20% of the allowed amount. 

 Do not write off the account with primary payer to $0.00. Bill the patient/secondary 20%.

MEDICARE BAD DEBT

 RHCs are allowed to claim bad debts in accordance with 42 CFR 413.80. RHCs may claim unpaid deductible. The RHC must establish that reasonable efforts were made to collect these co-insurance amounts in order to receive payment for bad debts. If the RHC co-insurance or deductible is waived, the clinic may not claim bad debt amounts for which it assumed the beneficiary’s liability. 

 Reasonable attempts must be made to attempt to collect the bad debt. Trail to show statements/billing in a routine pattern for 120 days. 

 Only services rendered during RHC effectiveness qualify to be written off for Medicare Bad Debt. 

 Medicare Bad Debt is reported in the year it was written off. 

 Any denials by Medicaid as secondary payer as long as claim was actually billed and denied 

 Documented charity write-offs