For Healthcare Professionals Office Management Billing & Coding Medicare Deductible, Coinsurance and Premium Rates for 2016 Print By Joy Hicks Updated November 11, 2016 More in For Healthcare Professionals Office Management Billing & Coding Staffing & Operations Patient Relations Personal Health Information Geriatric Care Healthcare Compensation Medical Technology Medical Supplies Medicare announced the updates to Medicare deductible, coinsurance, and premium rates for 2016. This provides detailed information on the increases to the yearly premium and deductible Medicare patients will have to face in the coming year. Just as an FYI, I listed a brief summary of the deductible and coinsurance amounts. This information can be used to inform your patients about their Medicare benefits as well as collecting upfront payments from your Medicare patients. Make sure your billing staff and front office staff are aware of these changes. Medicare Part A Hospital Insurance Hospital. Image courtesy of BSIP/UIG Getty Images Medicare Part A (Hospital Insurance): Most people get Part A as soon as they turn 65 without having to pay a premium. The only thing that would prevent a person from being eligible for Part A is failure to pay Medicare taxes while they or their spouse was working. Medicare Part A is called the hospital insurance because it helps pay for the care a patient receives in a hospital inpatient setting, critical access hospital, skilled nursing facility (SNF), hospice and home health care. Some Medicare Part A services include: Inpatient staySkilled nursing and rehabilitation services, supplies and mealsMedical and support of hospice (except home care)Home health aide services, only part time skilled nursing care, physical, occupational, and speech therapies, durable medical equipment, and supplies Medicare Part A pays by DRG (Diagnosis Related Groups). DRGs are assigned a classification based on a combination of ICD-9 diagnosis codes, CPT and HCPCS procedure codes, complications or conditions present on admission, discharge status, age and sex. DRGs payments are also based on a certain time period which is an average number of days necessary for adequate treatment. Deductible Deductible per benefit period, $1,288.00 Coinsurance For days 1-60, $0.00 per dayFor days 61-90, $322.00 per dayFor days 91-150, $644.00 per lifetime reserve day Skilled Nursing Facility For days 21 thru 100, $161.00 per day Premiums Base Premium - $411.00 per monthBase Premium plus 10% surcharge - $447.70 per monthBase Premium with 45% reduction - $226.00 per month (30-39 quarters of coverage)Base Premium with 45% reduction and 10% surcharge – $246.40 per month Medicare Part B Supplementary Medical Insurance Yellow Dog Productions/Getty Images Medicare Part B (Supplementary Medical Insurance): This part of Medicare is optional to patients one they reach the age of 65 and charges a monthly premium. Part B covers most services not covered by Part A. Some of these include: Physician office visitsOutpatient hospital servicesOutpatient physical, occupational and speech therapyClinical laboratory servicesPreventative CareDurable medical equipment (DME)Medical supplies, eyeglasses, and prosthetic devicesAmbulance servicesFor a complete list of items, visit CMS.gov. Medicare Part B pays by Fee Schedule. A fee schedule is a complete listing of fees used by Medicare on a fee-for-service basis. Deductible Deductible per year, $166.00 Coinsurance 20% coinsurance Premiums Held harmless - $104.90 per monthNot subject to hold harmless - $121.80 It is important to understand Medicare billing requirements which can be somewhat complex. Consider attending training events and opportunities. Providers must ensure that those responsible for preparing and submitting claims to Medicare are aware of proper submission guidelines and regulations. There are several vendors available to obtain information up-to-date information regarding a patient’s Medicare benefits and current status. Patient eligibilityClaim historyBenefitsMedicare Secondary Payer (MSP) InformationMSP enrollment datesMedicare Advantage InformationMedicare Advantage enrollment dates More Information on Billing to Medicare JGH Tom Grill/Getty Images Medical office providers have 365 days from the date the patient is discharged to bill Medicare for payment. Medicare payments are typically made to the medical office 13 calendar days from the date Medicare receives a clean claim. Was this page helpful? Thanks for your feedback! Get tips on how to better manage your health practice. Email Address Sign Up There was an error. Please try again. Thank you, , for signing up. What are your concerns? Other Inaccurate Hard to Understand Submit Continue Reading