Medical Billing Forum
General Category => General Questions => : ste August 27, 2010, 04:48:44 PM
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A patient has Medicare as 1º and BCBS as 2º. The provider, from a specialty not recognized by Medicare (acupuncture), believes she can submit a claim to Medicare and after it is denied submit a secondary claim to BCBS and get paid for her services.
The first sentence in the first chapter of Michelle’s e-book on Medicare enrollment states, “In order for a medical provider to provide services to a Medicare patient, they must be a Medicare provider.” Since the above provider is not a Medicare provider isn’t her idea of getting paid by the 2º insurance little more than a pipe dream, not to mention the possible legal entanglements?
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You need to have patient sign ABN.
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Sorry, that statement applies to provider types that are recognized by Medicare. In this case the provider should be able to bill the secondary directly since their specialty is not recognized by Medicare.
Also, Linda is right, get the ABN on file too.
Michele
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Yup, my bad.. lol Sometimes if a provider isn't recognized by Medicare the secondary will still give you a problem and want the EOB, in that case I usually copy the Medicare policy on those and send it off with a letter.