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 they’ve gotten that 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 when they enroll in the Medicare Program.

Note: RHCs and Federally Qualified Health Centers (FQHCs) must bill Medicare using the CMS-1450, also known as the UB-04, or electronic equivalent institutional claim format, not the CMS-1500.

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

• Unmet Part B deductible
• Part B 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.