Coding and Billing

2020 Medicare Part B Deductible Change: What You Need to Know

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

Feb. 5, 2020

Changes have been enacted for Medicare patients’ Part B deductible. Here are the details on this change, and how your practice will be impacted, including how this changed deductible will affect your coding and billing process.

Medicare Part B covers things that are not covered by Medicare Part A such as: physician services, outpatient hospital services, certain home health services and durable medical equipment. The Social Security Act requires each year that the Medicare premiums, deductibles and co-payment rates be adjusted.

For the year 2020, the Medicare Part B annual deductible is higher than the previous year. This chart shows the change:

The Medicare deductible resets every Jan 1. From a practice perspective, early in the year it is important to know if the patient has met their deductible or how much of the deductible has been met. The reason this is important is that you are expected to collect the first $198 from the patient if the deductible has not been met (or $198 minus any part of the deductible that has been met). If the patient tells you that you are the first doctor visit for them for this new year, then it is easy. The first $198 has not yet been met so it needs to be considered when calculating what the patient owes out of pocket today.

The more problematic situation comes when you are the second or third doctor they have seen this year. Now you have to determine how much of the deductible has been met and adjust it from the $198 annual deductible.

A practical suggest is to try to move your Medicare patients to later in the year when the odds are higher the deductible has been met. When a patient is seen in January this year and you need to see them again in a year for a medical reason, the patient would be better scheduled in December so that the deductible has probably been met.

References
https://www.cms.gov/newsroom/fact-sheets/2020-medicare-parts-b-premiums-and-deductibles

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