GUIDANCE Sliding Coinsurance for CMS/Medicare Care Management Services
Resource Topic: Clinical Issues
Resource Subtopic: Diabetes, —Quality Improvement, —Value-Based Health Care Transformation.
Keywords: Fees and Charges, Insurance and Claims.
Year Developed: 2020
Resource Type: Publication
Primary Audience: C-Suite (CEOs, CFOs, CIOs, COOs, CMOs, etc.); Clinicians,PCAs
National Association of Community Health Centers
(See other resources developed by this organization).
Resource Summary: While health centers are required to impose Medicare coinsurance for CMS/Medicare care management services, the coinsurance may be “slid” commensurate with the sliding fee discount program (SFDP) policy of the health center.
Federal anti-kickback statutes and beneficiary inducement prohibitions include exceptions allowing health centers to discount coinsurance for patients who are eligible for the health center’s sliding fee discount program without violating Medicare rules.