Palmetto recently upped the ante for claiming Medicare / Medi-Cal bad debts for California providers as described in their recent letter to providers (download here).
Medi-Cal Share of Cost (SOC) is a small co-payment that some Medi-Cal patients are required to pay. Previously Palmetto allowed a 2% reduction of crossover bad debts as an estimated amount of SOC in lieu of reducing by the actual SOC.
Now, Palmetto is requiring providers to reduce their bad debts by the actual SOC. If any SOC was actually collected on a claim, then the corresponding Medicare bad debt would be reduced by that amount. If any amount of SOC was uncollectible, then to claim the bad debt for that portion, the provider would have to prove that they made reasonable collection efforts, a difficult process in many cases, and doubly so when trying to collect from Medi-Cal beneficiaries. (more…)
The Patient Protection and Affordable Care Act (ACA) is an ambitious endeavor to improve health care in the United States. One of the ACA’s key features is the Accountable Care Organization (ACO). ACOs will contract with the Centers for Medicare and Medicaid Services (CMS) to provide comprehensive coordinated services for a defined population of Medicare beneficiaries. If they meet quality standards and reduce costs, ACOs will share in the savings.