Medical Billing Forum
General Category => General Questions => : honeybutta April 21, 2009, 01:13:49 AM
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Good evening. First time using this site and fairly new to billing.
If Medicare is primary and denies a charge for self administered drug as noncovered-claim is filed to secondary. If secondary pays a portion of the charge, but not all does the remaining part that has not been paid have to be adjusted?
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It would depend on the 2ndary carrier and if the provider participates with that carrier and what the carrier states is the patient's responsibility.
If the provider does not par with the 2ndary carrier and Medicare states it is a patient responsibility then the balance can be billed to the patient.
Michele
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Could it be the "self administered drug" is a Part D benefit? You said "non covered claim" so I'm only guessing without the exact denial code/explanation.Also did you submit to secondary with the Medicare Rejection?
Linda Walker
PMRNC
www.billerswebsite.com