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Oklahoma Rural Health Conference April 13, 2011. Medicare Bad Debts. Medicare Bad Debts . How do we get them paid?. Medicare Bad Debt Criteria. Debt must be related to covered services and derived from deductible and coinsurance amounts

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medicare bad debts

Medicare Bad Debts

How do we get them paid?

medicare bad debt criteria
Medicare Bad Debt Criteria
  • Debt must be related to covered services and derived from deductible and coinsurance amounts
  • Provider must be able to establish that reasonable collection efforts were made
  • The debt was actually uncollectable when claimed as worthless
  • Sound business judgment established that there is no likelihood of recovery at any time in the future
medicare bad debts4
Medicare Bad Debts
  • Careful completion of worksheet in Exhibit 5 of 339 format must be accomplished for allowance of bad debts
  • MACs are starting to require information not on Exhibit 5 form – collection agency return date.
medicare bad debts data to submit on lists
Medicare Bad DebtsData to Submit on Lists
  • Must include the following:
    • Patient name
    • HIC number
    • Service date(s)
medicare bad debts data to submit on lists6
Medicare Bad DebtsData to Submit on Lists
  • Must include the following:
    • Indigent status – must indicate Y or N – can be due to Medicaid as secondary or charity status
    • If indigent is due to Medicaid as secondary then must include Medicaid beneficiary number
    • If Medicaid is secondary must bill to receive denial/verification of secondary coverage
medicare medicaid crossovers
Medicare / Medicaid Crossovers
  • Beginning January 1, 2010 OHCA reduced the amount they would pay on crossover claims to –
    • 75% of the deductible
    • 25% of the coinsurance
how to handle crossovers
How To Handle Crossovers
  • Medicare assumes patients with Medicaid as secondary are indigent
  • As soon as Medicaid pays on claim, the remainder of the deductible and coinsurance can be written off and claimed as a Medicare bad debt.
medicare bad debts data to submit on list
Medicare Bad DebtsData to Submit on List
  • Must include the following:
    • Date first billed to patient to collect deductible or coinsurance – if no secondary – is not required for indigent patients
    • Date written off as uncollectible – after all collection efforts have ceased – including those of collection agencies
medicare bad debts data to submit on list10
Medicare Bad DebtsData to Submit on List
  • Must include the following:
    • Medicare remittance advice date – the RA which shows deductible/coinsurance related to potential bad debt
    • Unpaid Deductible derived from Medicare primary service
    • Unpaid Coinsurance derived from Medicare primary service
medicare bad debts data to submit on list11
Medicare Bad DebtsData to Submit on List
  • Must include the following:
    • Recoveries should include amounts related to both amounts written off and claimed in prior years as well as any amounts recovered on claims for bad debts which may be included in the current year listing
medicare bad debts data to submit on list12
Medicare Bad DebtsData to Submit on List
  • Must include the following:
    • Total bad debts allowed – can not exceed amount of Medicare deductible or coinsurance from original claim and must be net of recoveries
medicare bad debts data to submit on list13
Medicare Bad DebtsData to Submit on List
  • Must include the following:
    • Must identify which program bad debt relates to
      • Part A Inpatient, Part B Outpatient
      • Skilled Swing Bed, Skilled Nursing Facility
      • Inpatient Rehab, Inpatient Gero-psych
      • Rural Health Clinic
medicare bad debts must have to be allowable
Medicare Bad DebtsMust have to be allowable
  • Must include the following:
    • Cannot claim bad debts until all active /passive collection efforts cease
    • Must document collection effort in patient files
    • Must treat all patients the same with respect to use of collection agency
medicare bad debts what should not be on list
Medicare Bad DebtsWhat Should Not Be On List
  • Bad debts related to deductibles or coinsurance from fee schedule payments are not allowed
    • Part B therapy – PPS
    • Ambulance
    • Physician professional services – other than those which can be billed on a UB-04 as RHC services
    • Physician services billed under Method II
medicare bad debts problem we don t have no stinking problem
Medicare Bad DebtsProblem? We don’t have no stinking problem!
  • Oklahoma state average was 4% to 7% of Medicare deductible and coinsurance for the years 2005 to 2009
  • Look at that backwards – are you collecting 95% of Medicare deductible and coinsurance?
medicare bad debts where are we missing the boat
Medicare Bad DebtsWhere are we missing the boat?
  • Early write off
  • Financial class changed
  • Cavalier about write-off codes
  • Multiple bad debt codes
  • Not billed – patient
  • Not billed - secondary
medicare bad debts i want to fight
Medicare Bad DebtsI Want to Fight
  • Protests
  • PRRB Appeals
  • Administrator Review
  • Court
trailblazer audit
TrailBlazer Audit
  • Extrapolation of errors
  • Request for documentation
  • Bad debt policies
how to contact us
How to Contact Us

S. Craig Steen, CPA

Senior Managing Consultant

Tulsa, OK

918.584.2900

ssteen@bkd.com