Health Coverage Information
Medical - Bad Debt Reimbursement
Aetna will make additional payments for bad debt to facilities eligible for bad debt reimbursement in accordance with the Centers for Medicare and Medicaid Services (CMS) guidelines set forth in Chapter #3 of the CMS Provider Reimbursement Manual (Publication 15-1 - CMS Provider Reimbursement Manual - Part 1) ("CMS Guidelines"). In accordance with CMS Guidelines, Aetna will reimburse such eligible facilities a percentage of uncollectible bad debt that results from unpaid Aetna Medicare Open Plan (PFFS) member out-of-pocket costs.
What types of facilities can submit a request for Bad Debt reimbursement to Aetna?
Hospitals may submit a request for "eligible" bad debt reimbursement to Aetna after making reasonable and customary collection efforts. As outlined in CMS Guidelines, facilities will receive 70% of their eligible bad debts, with the exception of Critical Access Hospitals, Rural Health Clinics and Federally Qualified Health Centers. Critical Access Hospitals, Rural Health Care clinics, and Federally Qualified Health Centers will receive 100% of their eligible bad debts.
What is eligible Bad Debt?
"Eligible bad debt" is defined as uncollected cost sharing (i.e., copayments, deductibles or co-insurance) that was applied to covered services rendered by the eligible facility under the Aetna Medicare Open Plan that an Aetna Medicare Open Plan member is directly responsible to pay, and that the eligible facility was unable to collect from the member despite reasonable efforts.
When can Bad Debt be submitted to Aetna?
Eligible facilities may submit a request for eligible bad debt to Aetna no less than 120 days from the date the Aetna Medicare Open Plan member received the first bill for the claim in question.
How is Bad Debt Submitted to Aetna?
Eligible facilities must completely fill out either the Aetna PFFS Bad Debt Web Form and submit, or print the Aetna PFFS Bad Debt Report (1 page) and fax to Aetna at 860-754-2171. In the Bad Debt submission, facilities may only list the amount of cost-sharing charged for covered services under the member's Aetna Medicare Open Plan that could not be collected from the member despite reasonable efforts at collection, net of any partial amount(s) collected by the facility. Charges for services that are not covered under the Aetna Medicare Open Plan may not be listed in the Bad Debt Report.
Bad Debt Reports can not be mailed to an Aetna claim address.
Who do I call with questions on Aetna's Bad Debt program?
Contact the Aetna Provider Service Center at 1-800-624-0756.
Additional Program Guidelines
You may not request reimbursement of eligible bad debt until 120 days have passed from the date the Aetna Medicare Open Plan member received the first bill for each claim listed on this Bad Debt Report.
List only the amount of cost-sharing charged for covered services under the member's Aetna Medicare Open Plan that could not be collected from the member despite reasonable efforts at collection, net of any partial amount(s) collected from the member.
Charges for services that are not covered under the Aetna Medicare Open Plan may not be listed in this Bad Debt Report.
Please note that Aetna may request documentation relating to your efforts to bill and collect the bad debt listed on this Bad Debt Report.
Aetna Medicare Open Plan Terms and Conditions of Participation (Updated 02/22/08) (4 pages)
Aetna Medicare Open Plan Reimbursement Grid (Updated 04/24/08) (10 pages)
What Health Care Providers Need to Know About Private Fee-for-Service Plans (1 page)
CMS Provider Letter (2 pages)
Aetna Medicare Open Plan Quick Reference Guide (QRG) (Updated 04/18/08) (2 pages)
Aetna Medicare Open Plan Provider Q&As (11 pages)
"Zero" Copayments for Preventive Services (Updated February 2008) (2 pages)
Aetna Medicare Open Plan Summaries of Benefits for Individuals
Medicare Vaccine Information (Updated January 2008) (3 pages)
CMS 1500 Form (physician)
UB-04 Form (institutional providers: hospitals, SNF, HHC, etc.) (8 pages)
Health benefits are offered, underwritten or administered by Aetna Health Inc., Aetna Health of California, Aetna Health of Illinois, and/or Aetna Life Insurance Company. (Aetna)