Wiki Medicare primary and we are out-of-network with secondary

[CatchTheWind]

If the secondary payer does not pay because we are out-of-network with them (either they deny the claim or apply it to a large out-of-network deductible), are we allowed to write off the co-insurance since the patient would not have had to pay it if we had been in-network with the secondary?

 

[CodingKing]

Their only responsibility would be Medicare coinsurance or medicare deductible

 

[CatchTheWind]

Yes, but can we write off the co-insurance and deductible in this case? (Normally we aren't allowed to write them off unless the patient is a Medicaid QMB or has a financial hardship, but I'm wondering if we could write off the deductible and co-insurance in this case since we did make an honest attempt to bill the secondary.)

 

[thomas7331]

It is not considered compliant to routinely waive patient responsibility. I believe when the CMS/OIG refers to making an honest attempt to collect, the intent is that the provider will attempt to collect from the patient, and that it is acceptable to write off the balance only when there is a demonstrated financial hardship or inability to pay.

Part of the reasoning behind the government's stand on this is that they do not want providers giving patients a financial incentive to consume unnecessary or excessive health care services, so patients need to be made aware of their financial responsibility when seeking those services. So writing the balance off without ever billing the patient would not be appropriate.