Fee schedule vs. a la carte hospital bills

When dining, one consideration in choosing a restaurant is the concept of “a la carte” dining, which means “from the menu.” When you order a la carte you are ordering individual items, rather than a complete meal. The opposite of a la carte is a “table d’hôte,” which is a meal served at a fixed price. Cheerful couple with menu in a restaurant making orderThe total cost of a meal consisting of several la carte items tends to be much more expensive than that of a fixed price full meal.

A similar concept exists in health care. Someone might receive care at a hospital and then gets an itemized bill for each service provided. This is a la carte care and anyone who has gotten a hospital bill knows this tends to be very expensive. But health care has its own version of table d’hôte called the fee schedule. Fee schedules exist for such things as laboratory, therapies, and ambulance services to name just a few. And just like fine dining, fee schedule health care services are a fixed price.

When a Medicare beneficiary does not pay their responsibility for fee schedule amounts, Medicare has taken the position that since the items are a fixed price, there is no unrecovered cost attributable to uncollectible deductible and coinsurance arising from covered services.

Tip #25:

Bad Debts that arise under a fee schedule are not reimbursable on the Medicare cost report.

Guidance can be found on the Centers for Medicare and Medicaid Services (CMS) website. In addition, each MAC may have supplemental guidance on this issue.

Medicare Intermediary Manual – Transmittal 1872

Questions? Please contact Marie White at 612.253.6546 or mewhite@eidebailly.com.

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s