For 2017, Medicare has announced a 10% increase in its premiums and deductibles for Part B, which encompasses physician and outpatient services. Medicare Part B premiums are deducted from a beneficiary’s monthly Social Security payment while deductibles are patient financial responsibility that must be collected by the health care provider. Deductibles re-set annually on January 1.

The annual Medicare Part B deductible has increased from $166 in 2016 to $183 in 2017. Odds are, if your urgent care is seeing Medicare beneficiaries in January, they have not yet met their 2017 deductible and are thus responsible for the cost of services received.

Medicare is a cost-sharing program, which like commercial insurance, seeks to curb utilization by requiring beneficiaries to contribute to the cost of services they receive. Medicare pays no medical bills until the deductible has been met. After a patient has met his annual deductible, he is also required to contribute 20% of the cost of health care services, which occurs in the form of co-insurance. For urgent care, generally this amount will not exceed $20-30.

To maximize overall reimbursement, accelerate accounts receivable, and reduce patient collections, urgent care providers should train front desk staff and educate patients as to their obligations under Medicare.

Talking points for patients and the front office staff:

  • Medicare deductibles reset on January 1.
  • Medicare deductible for 2017 is $183.
  • Patients must pay the first $183 of medical services received in 2017 before Medicare pays any bills.
  • Above and beyond the deductible, Medicare patients are responsible for 20% of the cost of services received.

Collecting all patient financial responsibility at the time of service, even if a refund may later be issued after the claim adjudicates, benefits the center with faster collections and benefits patients with cost savings versus the center carrying and billing consumer receivables.

Monica Klosa is Chief Operating Officer of PV Billing, part of Practice Velocity.