Q&A: Determining the patient's financial responsibilty

September 10, 2018
Medicare Web

Q: What is a patient's financial responsibility under Medicare Part B benefits?

A: A patient receiving outpatient services might be responsible for an out-of-pocket expense. Although a patient under Part A could be held liable for multiple deductibles in a given year, a patient under Part B is only responsible for an annual deductible with certain exceptions. Once the deductible is met, the patient will not be responsible for a deductible again until the following year. But although the deductible only must be met once in a year, Part B patients are responsible for coinsurance for every visit to the hospital, with certain exceptions. A patient will be held responsible for the 20% coinsurance only after meeting the annual deductible. There are certain preventive services that are exempt from either the annual deductible, 20% coinsurance, or both. Examples of preventative services that will not have deductibles or coinsurances associated with them include the following:

  • Screening colonoscopy
  • Screening fecal occult blood test
  • Bone mass measurement (bone density test)
  • Diabetes screening

Everyone in the revenue cycle process should be familiar with which services will leave the patient with an out-of-pocket balance and which, like the preventive services listed in this section, will not.

For more information, see The Contemporary Guide to Patient Financial Services.