Ask the Expert: CMS Statements for Medicare Patients

Q: Is it mandatory for CMS to send all Medicare patients a summary statement after discharge (at bill drop) with a line stating “This is not a bill,” “Pending insurance,” or something similar? 

A: There are no CMS regulations that require Medicare patients to receive a statement. CMS’s focus on patient notification was to ensure that Medicare patients receive the same collection/statement process as all patients in order to claim an unpaid Medicare patient balance as a bad debt. Many states, including Illinois, put regulations in place related to timely patient notification of the availability of financial assistance/charity, as well as a statement that includes a summary of charges. Illinois requires a statement to all patients that includes disclosure of financial assistance.

Even though there are no CMS regulations, each hospital should check with their state’s attorney general’s office. Most hospitals do not send itemized statements. Some hospitals send an initial statement indicating Medicare has been billed, and no other statement is then sent unless there is a patient portion. Nearly 99 percent of Medicare patients have a supplemental insurance that covers the Medicare out of pocket; however, this could change in the future due to economic changes and new healthcare regulations causing Medicare patients to opt out of the supplemental policies. 

Susan Adams, revenue cycle consultant, HFMA, answered this question.

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