Case Management

CMW Tip of the Week: Discounts to uninsured or underinsured patients

Case Management Weekly, April 8, 2009

Hospitals may discount services to uninsured and underinsured patients who are unable to pay their hospital bills. According to the Office of Inspector General guidance for providing discounts, hospitals:

  • Should reflect full uniform charges on the Medicare cost report and inform the Medicare administrative contractor that it has reported its full charges
  • Can forgo collection efforts aimed at a Medicare patient if the hospital documents the patient is indigent or medically indigent
  • May claim discounted amounts as Medicare bad debt after determining that no source other than the patient is legally responsible for the unpaid deductible and coinsurance.
  • Can determine their own indigent-care criteria if they uniformly apply it to Medicare and non-Medicare patients

This tip was adapted from the Compliance Program Effectiveness Handbook. For more information on how to order your copy, visit the HCMarketplace.

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