In Part A patient is responsible for deductible(s) depending on number of days in hopsital (for example, $952 for a stay of 1-60 days). QMEM calculates Provider Write-off as Amount Billed minus Amount Allowed. With other insurers My Responsibility is Amount Allowed minus Insurance Payments.
If hospital charges, for example, $10,000 and Medicare approves $10,000 and pays $2,000 but patient only resposible for $952, say, how do QMEM users account for the $7048 difference?
A. State lower Amount Allowed so Write-Off takes care of difference?
B. Put the $7K as Insurance Payment using a fake insurer such as "Extra write-off"? THIS DISTORTS PAYMENTS BY INSURERS.
C. Put the $7K as another My Payments & Copays with some fake source as in B above? THIS DISTORTS MY PAYMENTS.
D. ???
THANKS for sharing your thoughts on this. I really don't want to follow anwers B nor C, and am looking for what other solutions users have devised.
Re: Medicare Part A - Charged vs Approved vs Liability Nov 10, 2006 05:19 am
In Part A patient is responsible for deductible(s)
depending on number of days in hopsital (for example,
$952 for a stay of 1-60 days).
QMEM <v 2.0>
calculates Provider Write-off as Amount Billed minus
Amount Allowed.
So far, so good.
With other insurers My Responsibility
is Amount Allowed minus Insurance Payments.
That's true in QMEM also.
If hospital charges, for example, $10,000 and
Medicare approves $10,000 and pays $2,000 but patient
only resposible for $952, say, how do QMEM users
account for the $7048 difference?
If the Provider only receives $2952 on a $10,000 charge ... then the write-off is $7048 and the "allowed" is $2952. Medicare's "approval" of $10,000 doesn't mean much is neither they nor you are paying it.
What you have to watch out for is that EVERY insurance co. uses slightly different terminology ... and QMEM can't possibly match them all ... so you have to work with the concept rather than the precise terminology on your EOB.
db
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Edited by dbAnalyst at 11/10/2006 1:19 PM
THINK IT THRU! Have you explained your issue so that someone who knows nothing about you, or YOUR Quicken setup, can understand what your issue is? Are you using standard Quicken terminology, particularly with respect to FILES, ACCOUNTS and CATEGORIES?
Re: Medicare Part A - Charged vs Approved vs Liability Nov 10, 2006 05:30 am
Thanks, dbAnalyst. One vote plus (my current M.O.) for choice A.
You are also right that Amount Allowed is apparently of little/no consequence except as a means of getting from Amount Billed to how much I have to shell out.
Re: Medicare Part A - Charged vs Approved vs Liability Nov 10, 2006 08:06 am
I vote for answer "A" also. And agree with dbAnalyst... if neither the insurance company nor you pay the hospital, then ultimately the hospital "writes-off" that amount.
