When billing Medicare for your care, KSB is required to follow the rules that Medicare has in place to ensure appropriate payment of your medical claims.
It is important to us that you are kept informed of your responsibility; our goal is to make this process as seamless as possible for you.
This page includes information on a few common Medicare requirements that patients may encounter for services provided at KSB.
Advanced Beneficiary Notice (ABN)
An ABN informs Medicare patients in advance which procedures or testing may not be covered before receiving services. Examples of services that require an ABN are mammography, bone density, various lab tests, and some office procedures.
If the service provided is not covered by Medicare, a signed ABN form is required. The form indicates the patient’s acceptance of financial responsibility for non-covered services and allows KSB to bill the patient.
As a patient, there are 3 options to choose from when signing an ABN form:
- I want the item(s) or services listed on the form and understand I am responsible for any non-covered services
- I want the item(s) or services listed on the form but do not want KSB to bill Medicare
- I do not want the item(s) or services listed on the form
What if I refuse to sign an ABN, but I want the items or services anyway?
- If you refuse to sign, one of two actions will take place:
- KSB may decide not to provide the items or services.
- A second person will witness your refusal to sign the agreement, and you will receive the items or services. However, you may be held liable because you have been notified of the likelihood of a Medicare denial.
If a form is required for your care, a KSB team member will discuss this with you during your visit.
Medicare Secondary Payer Questionnaire (MSPQ)
The MSPQ is required by Medicare to identify services for which Medicare does not have primary payment responsibility – that is, when another entity has the responsibility for paying before Medicare.
Such times where Medicare is not the primary payer would be when other benefits are in place such as Workers’ Compensation, Federal Black Lung benefits, Veteran’s Administration (VA), or a Group Health Plan through a patient or spouse’s employer.
When billing Medicare for services provided at KSB, Medicare requires KSB to ask a series of questions to determine the primary payment source.
Questions in the MSPQ include:
- Are services to be paid by Black Lung Benefits, government research programs, or Veterans Administration?
- Are services related to a work-related accident/condition?
- Are you entitled to Medicare based on age, disability, or end stage renal disease (ESRD)?
- Are you or your spouse currently employed/retired?
- If retired, what are specific retirement dates?
If you have any other general billing questions or concerns, please feel free to reach out to our Patient Advocate Team at 815-284-4YOU (4968) or to contact Medicare directly, call 1-800-MEDICARE (1-800-633-4227).
All Medicare rules, regulations, and processes such as the above mentioned can be found on the Centers for Medicare & Medicaid Services (CMS) website at www.cms.gov.