Billing Medicare when Non-Medicare Provider

[barb2512]

Does anyone have experience billing Medicare as primary with CareFirst BCBS of Maryland as secondary when the provider is not a medicare provider? Billing out patient mental health cpt codes 90801 and 90806.

Our claims keep getting kicked out. It gets harder and harder to get a CareFirst bcbs representative on the phone at all, let alone one that is familiar with Medicare.

I have been told by CareFirst in the past to mail medicare claims to medicare where they will be repriced and sent to CareFirst for payment. But Medicare is just dumping the claims.

Any help is appreciated.
Barbara

[DMK]

If I understand correctly, you should bill Medicare first (electronically if you can) for the denial, then send to the secondary.  That's the same as if the provider were par with Medicare.  HOWEVER, you have to be registered with Medicare to bill Medicare, Par or Non-Par, otherwise they don't even know who you are and will throw out the claims. 

I'm not sure that the doctor can even see a patient with Medicare if they don't bill Medicare.  The patient would pay at time of service and submit their claim themselves.  One of our urgent care facilities does not participate with Medicare and that's how they handle it.

[PMRNC]

Right and if the provider is taking patients on Medicare and is not a Medicare provider, the secondary in many cases follows Medicare.

[DMK]

It's also important to know the difference between SUPPLEMENTAL insurance and SECONDARY insurance.  Most Medicare patients purchase a SUPPLEMENTAL policy.  This will pick up co-pays and deductibles for items Medicare allows and covers.  A SECONDARY policy will do the same as the supplemental AND will often pay for services not covered by Medicare.  Secondary policies often have deductibles though so the patient may have out of pocket expenses.

[barb2512]

Wow thank you all so much. I will check these two things, to see if I can get the counselor registered with medicare and secondly to see if the client as secondary insurance or supplemental insurance.

I appreciate those that answered and all who looked at my problem.

Barbara