Concurrent Care-Medicare

[macbook]

Hello,

I would need your expertise again. 

I am always coming across this denial with Medicare for my Hospitalist physician. I have sent appeals with Medical records and some get paid and some do not. Is there another way of appealing this?

Also, if the claim is denied with Medicare inspite the appeals, can we still bill Medicaid or the secondary payer?

Any feedback would be appreciated.

Thank you,

[PMRNC]

You don't really give any information on the specifics of the denials, would need more information.

[macbook]

For one specific denial, we got denied because of concurrent care, another provider with the same specialty also billed Medicare for the same DOS. And both providers do not have a subspecialty. And since the other provider billed first, he is the one that gets paid according to the CSR. I did send an appeal with Medical records indicating my provider did render services to the patient, I still got a denial for concurrent care.

Is there any way we can avoid this in the future? What can I advice my provider to avoid this concurrent care denial. We do get a lot of this.

In relation to my previous question, if we were denied with Medicare should I also still go ahead and bill Medicaid when I know that Medicaid will follow the denial of Medicare?

Thank you so much for your help.

[PMRNC]

There's nothing you can do when another provider sees patient at same time, they are only going to pay one (one billed first). To prevent this I would guess you need to be quicker at submissions maybe billing same day would help in that situation, but more so I would think it would be in the provider's best interest to look into why there are two provider's in first place? You said it happens frequently? That would make me a little curious I suppose.

In relation to my previous question, if we were denied with Medicare should I also still go ahead and bill Medicaid when I know that Medicaid will follow the denial of Medicare?

I would still go ahead and bill it.

[macbook]

As always, thank you so much Linda for your help.