Feds to docs: Don’t bill qualified Medicare beneficiaries for co-pays

The federal government is putting practices around the country on notice: Qualified Medicare beneficiaries aren’t responsible for co-pays or other out-of-pocket costs. If doctors’ offices persist in billing these patients, they could be fined or even excluded from the Medicare program.

Medicare beneficiaries don’t have any legal liability to make payment to a healthcare provider in addition to the amounts paid by Medicare and Medicaid, according to federal law. Rather, physicians should accept the Medicare and Medicaid payment as payment for services provided to a qualified Medicare beneficiary, reports The New York Times.

Regardless, the U.S. Department of Health and Human Services has discovered that billing Medicare and Medicaid beneficiaries is a fairly common practice. Many beneficiaries will pay the cost-sharing amounts--often because they don’t know that they’re not required to pay or they’re worried about their doctors refusing to see them, reports the NYT.

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Most dual-eligible patients are 65 and older or disabled with low incomes--often less than $1,000 a month for a single person or $1,355 for a married couple, according to the news outlet.

Across the country, approximately seven million low-income people are considered qualified Medicare beneficiaries, which means that their co-pays, deductibles and other out-of-pocket costs are covered by state Medicaid agencies. Because states aren’t required to pay doctors for the full cost of providing these services to patients and sometimes pay nothing, often doctors have hundreds or even thousands of dollars worth of unreimbursed expenses, according to the NYT.

Often, doctors say they don’t know that a particular patient is a qualified Medicare beneficiary and, thus, not responsible for a co-pay. In response, the government is stepping up its efforts to educate both patients and doctors, the newspaper reports.

- read the article

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