Medicare vs Blue Cross allowable.

[Gary]

In the situation where Medicare is primary and Blue Cross is secondary, both having different allowable amounts, which allowable would one follow?  Case in point:  A $300 item is sold to the patient.  Medicare is billed for $300 and it pays 80% or $240.00.  Blue Cross is then billed as the secondary and they pay $0.00 because they have an allowable of $234.00 where Medicare has an allowable of $340.00.  The balance is $60.00.  Does the patient now pay the $60.00 as an upgrade to Blue Cross' $234.00 allowable?  Or, would it be advisable to bill Medicare $234.00 where they would then pay $187.20.  Blue Cross would then pay the remaining 20% or $46.80 and the patient would be billed the upgrade of $66.00. 
Thanks for the help.

[Pay_My_Claims]

You can't bill a Medicare patient for more than what's allowed by Medicare. If the item you mention is 340.00 and Medicare's allowable is 300 and they pay 240, the clients coins is the 60. If the 2ndary doesn't pay because it is over their allowables, then the patient can be billed for his coins. I don't know what upgrade you are speaking of except in DME where Medicare only covers a certain item but the client after signing an ABN can receive the upgraded (wheelchair/bed etc) and pay the difference. WE however have to bill Medicare for the Upgraded item, but they will downcode, and thus we can bill the patient.

[Michele]

You should bill the regular fee of $300.  Look at the BC eob and see if it states the patient responsibility as $0 or as $60.  If you are a participating provider with both Medicare and BC you need to make sure you are not breaking your contract by billing the patient.  Medicare is saying the patient is responsible for the $60, but what is BC saying.  You may also want to call BC or check with your BC provider rep to clarify this.

Michele