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ABN Use and Co-Insurance/Co-Pay Collection

  1. #1
    Location
    Coeur D'Alene, Idaho
    Posts
    39
    Question ABN Use and Co-Insurance/Co-Pay Collection
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    I work for a new ASC (we opened our doors in May), and we *finally* got our CMS approval effective 12/7/09. And I have a question regarding co-insurance/co-pay collection for patients that have Medicare replacement plans such as Sterling or Secure Horizons.

    We were told that we could treat Medicare patients so long as we notified them that we were unable to bill their insurance and have them sign an ABN stating that we could not bill Medicare because we were still awaiting CMS approval.

    So for example, a Sterling patient comes in for a colonoscopy. We verify their eligibility with Sterling and what their co-insurance will be for a colonoscopy in an outpatient setting. Let's say it's 10%, so on the day of surgery we collect 10% based on the Medicare allowable for outpatient centers in our area as well as have the patient sign the ABN. Is this allowed?

    Basically, can we collect co-payment (not the portion the plan would normally pay) from patients with Medicare replacement plans for Medicare covered services if we were a non-covered provider?

  2. #2
    Default eguerrero
    Ash, is your center contracted with Secure Horizon?

  3. #3
    Location
    Coeur D'Alene, Idaho
    Posts
    39
    Default
    Not as of yet, we're still awaiting our Medicare Provider number. We intend to become a provider with them as soon as we're able, but it's my understanding we should be able to bill retroactively to our CMS accreditation approval date of December 7th.

    Our concern is over the patients we saw prior to that approval that we had sign the ABN and pay their co-insurance.

  4. Default
    Here is a link to the CMS Q&A regarding replacement plans and non-contracted providers. I hope it helps.

    Because deemed status was applicable in 2009, from the reading of this Q&A, I would think the rules relating to treating Medicare patients as a non contracted payer would also would apply to the replacement plans.

    http://www.cms.hhs.gov/PrivateFeefor...ads/Provqa.pdf
    Last edited by MMAYCOCK; 01-06-2010 at 09:50 AM. Reason: posting the link

  5. #5
    Location
    Coeur D'Alene, Idaho
    Posts
    39
    Default
    This is just the answer I was looking for, thank you so much!

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