By: Susan McClelland, BS, FICC, McClelland Consulting LLC
As you probably know by now, a new law was passed recently that postponed the scheduled 21.3% cut in Medicare reimbursement rates until November 30, 2010. In addition, this law gave providers a 2.2% increase, retroactive to June 1, 2010.
Please note that, by increasing the fees, it also increased the patients’ portion (co-insurance).
Under Part B or “original” Medicare, patients owe 20% of the Medicare allowable and providers are required to collect it or risk fines and penalties. However, the OIG (Office of Inspector General of the US Department of Health and Human Services) has released a statement stating that physicians can legally waive this extra amount rather than go through the trouble of collecting it (full OIG statement:
http://oig.hhs.gov/fraud/docs/alertsandbulletins/Retroactive_Beneficiary_Cost-Sharing_Liability.pdf).
While Congress was working on the Medicare fee schedule issue, CMS suspended processing claims through June 17. During the period of time between June 1 and June 17, many providers were collecting co-insurance from their Medicare patients based on the lower rate. As of June 18, Congress had not resolved the reimbursement issue and, since the claims-hold period had expired, Medicare carriers began processing the suspended claims at the lower rate. Once the new legislation passed, CMS promised that its contractors would reprocess any June claims paid at the lower rate to reflect the new rate (if the charges submitted exceeded the new fees).
Unfortunately, that still left the matter of patients possibly owing more in coinsurance than they had paid. For many charges (including CMT), the increase was minor (<$5). Most Doctors of Chiropractic will probably not want to bill patients for this additional amount of coinsurance, especially since it is so small. For one thing, the cost of mailing a bill is approximately $5, which exceeds the amount of additional coinsurance in most cases. In addition, receiving a second bill for such small amounts could potentially annoy patients.
The OIG directive is designed to relieve us of this problem. It gives you permission to waive the additional coinsurance amounts that resulted from the higher fee schedule applied retroactively (
please note you are not required to waive this amount).
Ordinarily, the waiver of co-insurance is prohibited. However, you will not be subject to fines and penalties under the following conditions:
• The OIG policy statement applies only to amounts owed for services furnished during the Retroactive Period. Once the new payment rates are implemented, you are expected to calculate and collect the patient portion based on the new payment rates (you can find these new fees on your contractor’s web site).
• The OIG policy statement applies only to the increase in the beneficiary's cost-sharing amount attributable to the increase in payment rates.
• The OIG policy statement applies only if:
You uniformly offer the waiver to all affected beneficiaries; and
You do not offer the waiver as part of any advertisement or solicitation.
• The OIG policy statement does not apply if the waivers are conditioned in any manner on the provision of items, supplies, or services.
Again, nothing in the OIG policy statement requires you to waive the additional co-insurance.
