Charging Patients

The Medicare Health Insurance Benefit Agreement, Form CMS-1561 or Form CMS-1561A for RHCs, requires providers to agree not to charge Medicare patients for any service the Medicare Program paid for on their behalf. The provider’s Authorized Official, as defined in 42 CFR section 424.502 must sign the Health Insurance Benefit Agreement at the time they enroll in the Medicare Program.

The provider may bill the patient for the following items as they apply to the provider type:

• Unmet Part A deductible
• First 3 pints of blood, which Medicare calls the blood deductible, if there’s a charge for blood or the blood isn’t replaced
• Part A coinsurance
• Services that Medicare doesn’t cover

To learn more about health insurance benefit agreements, review the Medicare General Information, Eligibility, and Entitlement Manual, Chapter 5.