Letter to the Editor: Changes to Medicare billing at PMC

Dear Editor:
This is an important letter to inform Medicare patients about a change in the Medicare Billing Process. Pioneers Medical Center diligently works with Medicare to get patient claims filed and paid. We strive to keep patients apprised of their account status.

That is why we feel it is important to share changes to the current Medicare process that is affecting our local health clinic.
CMS (Centers for Medicare and Medicaid Services) implemented significant changes to the billing process for Rural Health Clinics, a designation by CMS that affects Meeker Family Health Center. Effective April 1, 2016, the billing of clinic Medicare claims has become a more complex, detailed process that will result in delayed reimbursement for many types of services, including skin lesion removals, nail procedures, wound repairs, and trigger point injections. CMS has instructed Meeker Family Health Center to hold claims submissions for these types of services until Oct. 1, 2016. Because claims containing specific procedures have to be held for billing until Oct. 1, you will NOT receive a statement until after October 2016.
If you have received services from your physician that are not on the Medicare list of codes that have to be held, those claims will be billed to Medicare within several days of your visit. However, your statement may reflect what appears to be double charge for the doctor’s visit. Although it appears this way, it is the required data collection format. This is not the actual amount on your account balance in the Pioneers Medical Center system. This inflated amount will not affect what you or your secondary insurance will actually owe, which is 20 percent of the amount on your account balance in our health information system. Coinsurance and deductibles are still waived for certain preventive services. The government agency, Center for Medicare and Medicaid Services, is implementing this process to document and gather data for the types of procedures performed in a Rural Health Clinic.
Please be aware these changes will be reflected on your Medicare Summary and may be somewhat confusing. In order to help you better understand the charges, reimbursement, and patient responsibility, you are encouraged to call and speak to Marie Rogers (physician claims biller), 970-878-9287; America Haggart (physician claims follow-up), 970-878-9354 or me.
Thank you for your patience and understanding.
Danette Coulter
Patient Financial Services Director
Pioneers Medical Center

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