Long-Term Care

Simple steps to successfully collect coinsurance

Billing Alert for Long-Term Care, September 1, 2009

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Collecting Medicare Part A coinsurance amounts can be a headache for SNF billers because the payer source depends on the resident’s Medicaid status, type of insurance, and state rules.

As most billers know, Medicare Part A pays for all services during the first 20 days of a beneficiary’s Medicare-covered SNF stay. The resident, Medicaid, or a private insurer is then responsible for the coinsurance amount for days 21–100 of the benefit. Each year, CMS establishes a new Medicare Part A coinsurance rate; this year’s rate is $133.50 per day.

“Coinsurance billing can be confusing, and facilities that don’t stay on top of it tend to have bad debt problems,” says Jennifer Wormington, MBA, managing consultant at BKD in Springfield, MO.

SNF billers can avoid coinsurance billing problems by identifying the payer source upon admission, keeping track of uncollected amounts, and knowing the rules about bad debt write-offs.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

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