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.
