Provider Charges to Beneficiaries (Rev. 2921, Issued: 04-04-14)

by  Find-A-Code
July 17th, 2015

In the agreement/attestation statement signed by a provider, it agrees not to charge Medicare beneficiaries (or any other person acting on a beneficiary’s behalf) for any service for which Medicare beneficiaries are entitled to have payment made on their behalf by the Medicare program. This includes items or services for which the beneficiary would have been entitled to have payment made had the provider filed a request for payment (see §50).

The provider may bill the beneficiary for the following items:

• Part A deductible;

• Part B deductible;

• First 3 pints of blood, which is called the blood deductible (if there is a charge for blood or the blood is not replaced);

• Part B coinsurance;

• Part A coinsurance; or

• Services that are not Medicare covered services. See Chapter 30 for related requirements.

SNFs may not require, request, or accept a deposit or other payment from a Medicare beneficiary as a condition for admission, continued care, or other provision of services, except as follows:

• A SNF may request and accept payment for a Part A deductible and coinsurance amount on or after the day to which it applies.

• A SNF may request and accept payment for a Part B deductible and coinsurance amount at the time of or after the provision of the service to which it applies.

• A SNF may not request or accept advance payment of Medicare deductible and coinsurance amounts.

• A SNF may require, request, or accept a deposit or other payment for services if it is clear that the services are not covered by Medicare and proper notice is provided. See Chapter 30 for instructions about ABNs and demand bills.

• SNFs, but not hospitals, may bill the beneficiary for holding a bed during a leave of absence if the requirements in §30.1.1.1 are met.

Pub 100-04 Medicare Claims Processing Manual

References:

Provider Charges to Beneficiaries (Rev. 2921, Issued: 04-04-14). (2015, July 17). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/provider-charges-to-beneficiaries-rev-2921-issued-04-04-14-27247.html

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