Medicare Bad Debt
In a time of shrinking margins and decreasing government reimbursements, finding additional revenue through Medicare Bad Debt helps relieve financial strain—so you can focus on what matters most: caring for patients.
Key areas of focus
- Dual Eligible patients (Crossovers)
- Indigent Non-Dual Eligible patients (Charity)
- Non-Indigent Medicare patients (Traditional Self-Pay)
Medicare Bad Debt
In a time of shrinking margins and decreasing government reimbursements, finding additional revenue through Medicare Bad Debt helps relieve financial strain—so you can focus on what matters most: caring for patients.
Key areas of focus
- Dual Eligible patients (Crossovers)
- Indigent Non-Dual Eligible patients (Charity)
- Non-Indigent Medicare patients (Traditional Self-Pay)
Expertise in Medicare Reimbursable Bad Debt
At Reimbursement Recovery Partners, we specialize in recovering Medicare Bad Debt. Rather than relying solely on inconsistent write-off transaction codes in your patient accounting system, our process identifies Medicare bad debt with precision by reconciling every deductible and coinsurance dollar back to its final disposition.
Patient-Level Detail
We compile the data as required by the CMS-required Exhibit.
Dedicated Team
We assign every client with a dedicated Project Manager and Audit Support Expert.
Complete Audit Support
We provide supporting documentation and defend the accounts through to reimbursement.
Standing by You During Audits
In the event of an audit by your Medicare Administrative Contractor (MAC), we ensure your preparedness:
- Preparedness: We gather all required documentation.
- Expert Guidance: We minimize the risk of claim denials, reducing stress on your staff.
Our Comprehensive Approach
- Data Matching: We cross-reference the Medicare PS&R with patient accounting data, Medicaid paid claims, collection agency records, and hospital bad debt logs.
- Account Identification: Every bad debt account is tracked and documented thoroughly.
- Listing Submission: We submit reopening requests to your MAC with your authorization.
- Support Through Settlement: We provide support throughout audit sampling and settlement.
Our unmatched commitment to completing the job has become a hallmark of our service.
What is Medicare Bad Debt?
Medicare Bad Debt refers to uncollected deductibles and coinsurance for covered services. Medicare reimburses providers for 65% of allowable bad debts, as outlined in 42 CFR 413.89 and the Provider Reimbursement Manual–Part 1 (PRM-1), Sections 306–324.
Criteria for Allowable Medicare Bad Debt
For your hospital to receive proper reimbursement, these criteria must be met:
Related to Covered Services
The debt must involve deductible and coinsurance from Medicare-covered services.
Uncollectible Debt
The debt must be deemed uncollectible when claimed.
Reasonable Collection Efforts
Genuine efforts must have been made to collect the debt.
No Future Recovery
Business judgment should indicate that the debt is unlikely to be recovered in the future.
Navigating the Medicare Bad Debt 120-Day Rule
- Clock Starts: The 120-day period begins on the date of the first bill to the patient or secondary insurance.
- Payment Resets: Any payment received restarts the 120-day window.
- Our Support: We help track these timelines to ease the burden on your team.
Avoiding Non-Allowable Bad Debts
- Non-Medicare Recipients
- Physician/Professional Fees
- Presumptive Charity
- Medicaid Spend Down
- Fee-Schedule Coinsurance Amounts