Charging Patients

The Medicare Health Insurance Benefit Agreement, Form CMS-1561 or Form CMS-1561A for rural health clinics (RHCs), requires you to agree not to charge Medicare patients for any service the Medicare Program paid for on their behalf.

Your authorized official, as defined in 42 CFR section 424.502, must sign the Health Insurance Benefit Agreement when he or she enrolls in the Medicare Program.

You can bill a patient for the following items as they apply to your provider type, unless the patient’s supplemental insurance covers the costs:

• 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, review the Medicare General Information, Eligibility, and Entitlement Manual, Chapter 5.