It’s January, the start to a new year…and the start of a new year for Medicare Part B claims as well. If you are new to Medicare, and even if you aren’t, we want you to be prepared to expect to receive bills related to the deductible. Here’s a refresher on the topic.
Each year Medicare requires that beneficiaries meet their deductibles BEFORE Medicare will begin payment for charges submitted to them. Some services, such as lab work and certain preventive services, are not subject to the deductible. The Part B deductible for 2017 is $183. This means that the first $183 of allowed charges by any medical provider are the subscriber’s responsibility to pay. The $183 is not per provider: it is a collective amount for all medical providers.
To illustrate further: a Medicare subscriber sees a doctor who participates with Medicare. The doctor charges $150 for the visit. The doctor submits the claim for those services to Medicare for processing and payment. According to Medicare, the allowed charges for that visit at $97.53. The subscriber has not met any of the $183 deductible so Medicare applies that amount to the deductible and instructs the doctor that the patient is responsible to pay that amount. The doctor then bills the subscriber $97.53. This leaves $85.47 in future medical charges that the patient is responsible to pay in order to meet the full deductible. Once the $183 deductible is met, Medicare will begin to pay 80% of the allowed charges for submitted claims. Please note: the deductible is based on ALLOWED charges, not on the amount of the charges billed by the doctor. The allowed charges are typically lower than the actual billed amounts.
While it is standard practice that patients only receive bills from doctors and facilities after claims have been submitted to and processed by all insurances for a patient, there are some doctors who do not want to wait the 4-6 weeks it may take for this process to conclude in order to be paid. Some request that the deductible be paid upfront at the time of the visit. Patients should be very careful about making these upfront payments and here’s an example that illustrates why:
Medicare processes claims on a first come, first served basis. This means that the first doctor to submit a claim to Medicare will be subject to the remaining deductible, regardless of the date that those services were rendered. If a patient pays the deductible to Doctor A at the time of the visit, and subsequently sees Doctor B without paying a deductible, and Doctor B’s claim is received by Medicare before Doctor A’s claim, Medicare will apply the charges to Doctor B’s claim. The patient will be responsible to pay that deductible balance to Doctor B even though the patient already paid Doctor A the same balance. The patient will now need to contact Doctor A to request a refund for the payment that was made in error.
So to avoid paying the deductible to the wrong doctor, or to avoid paying the wrong deductible amount, don’t make upfront payments. Wait until the claims are submitted and properly processed by Medicare so that Medicare can tell you exactly who should be paid and how much they should be paid.
For this or any other complicated claims processing questions, it could be helpful to enlist the guidance of a qualified medical billing advocate. Their hands-on experience uncovering medical billing errors and negotiating disputed medical bills, can translate into significant savings for you.