The premium continues to be means-tested based on the income of single or married beneficiaries, increasing to a maximum of $335.70 per month for those beneficiaries with individual income of greater than $214,000 or joint filers with combined income of $428,000. A married beneficiary who files a separate tax return will hit the high premium level with an income of $129,000.
Flat premiums and deductibles are certainly good news for your Medicare patients, a good number of whom are on fixed income. There remains the challenge of collecting the $147 from the patients, which typically makes January a lean cash-flow month for Medicare-dependent practices.
Remember, Medicare applies the deductible to claims in the order in which they are processed by the Medicare Administrative Contractor. Certain claims are exempt from the deductible – most notably Medicare covered screening services, the initial and subsequent Medicare Annual Wellness Visits and the Initial Preventive Physical Exam.
Here are some tips to help you through:
- If you know the patient is seeing multiple physicians for treatment of multiple conditions, you can hold claims for a few days to see if the other provider claims hit Medicare’s payment system first. This won’t work, of course, if everyone does it.
- When the patient knows he or she has not seen a physician yet that year and will hit the deductible, collect the full allowed charge at the time of the service. Note that you’ll need to return it promptly if the claim is denied and not successfully appealed. It’s critical you know the Medicare allowed charges for your area if you take this approach.
- When patients who owe you money against the deductible make a subsequent appointment, inform them of the balance and let them know payment is expected prior to the service, via cash, check or credit card. Set an expectation of timely payments at your practice.
- When patients you see rarely have claims that hit the deductible, set those aside for billing or phone follow-up. It’s not financially feasible to spend a lot sending invoices or calling patients on the standard 20 percent deductible of an E/M service, but it’s worth your while for a balance that could approach $100.
- Be prepared to calculate and have handy the balances for those patients whose claims are partially impacted by the deductible. Let’s say a patient still has $47 of deductible left to meet for a covered service with an allowed charge of $100. The patient will owe you $67 (20 percent coinsurance plus the $47) and you should be paid $33 by Medicare. We used easy figures to cover up this writer’s own math deficiencies – the world of allowed charges and coinsurance never works out that smoothly.
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