Charging Full Fee for Medicare Adjustment

Once a Medicare patient has completed his treatment plan he should be treated thereafter on maintenance care which is not payable under Medicare rules. Although maintenance adjustments are not payable, they are still a covered service and must be filed.

In order for you to be paid for these adjustments the patient should sign an ABN agreeing to pay out-of-pocket.

If the patient has signed a Valid ABN, then the doctor may bill and collect his usual fee for the adjustment. (Medicare Claims Processing Manual; Chapter 30 – Financial Liability Protections; 50.15 – Collection of Funds and Refunds)

How to create a valid ABN is covered in our ‘Medicare ABN’ course.


FormSmith Software Instructions

When an adjustment is keyed in on a Medicare patient you should be presented with the ‘Medicare Collection, Verification and ABN’ screen (if not call support).

Then if Maintenance AND patient signed ABN for this service are selected, then the Regular Fee button becomes active. Clicking it will cause the patient to be charged your regular fee.


If you need powerful, reliable, supported and easy to use practice management software take a look at FormSmith

If you need Medicare training take a look at our Medicare Course