Medicare as Secondary Payer

[LisaB53]

Hello Everyone,

I am not a professional biller I just try to help my cousin out as best I can.  He is a Chiropractor and is semi retired.  He has mostly cash clients and I bill his medicare clients.  The only insurance company he participates with is Highmark Blue Cross and Blue Shield.

He has a patient that was using Medicare but now has signed on with a PPO.  The PPO insurance company will not pay because he is not a participating provider.  After the denial remittance comes back from the insurance can he then bill Medicare?  I didn't know how something like this might work.  Maybe Medicare figures it's his problem since he doesn't participate with the insurance company.  I wanted to ask about this before he has me send a bill to his patient.

I really don't know how you all do this, I find it so very confusing.

Thanks,
Lisa

[DMK]

If the PPO is a Medicare replacement plan it (the PPO) is now the insurance you bill, not Medicare.  Medicare isn't secondary either.  We run into this more and more.  The doctor must be on the plan IF the plan only pays in-network.  There's no way around it. 

Also, if he does participate with the plan make sure you still code it EXACTLY like you would code for Medicare and BE SURE to document the same as Medicare.

[LisaB53]

Thank You for the information.  My cousin is pretty old fashion and when I asked him if he wanted me to help him register with the insurance company he said no, he's tired or playing all these games.  I guess he's lucky that he is starting to wind down his practice.

Lisa

[DMK]

I completely understand the desire to not play the game!  Unfortunately, it's part of the healthcare business.  It's everchanging and ever will be.

[PMRNC]

I've done more de-credentialing in the past year than credentialing.. LOL  BCBS contracts are the worst to get out of. I've also been getting doctors out of Medicare and Medicaid like crazy, I try to tell them they are being pre-mature because I don't see Obamacare getting off the ground at all once the new president gets in there    But many of them said it's just one threat to many for them and they want out of govt sponsored plan's. I've also observed that the other carrier's are making it even easier for doctors to sign up now and that once closed panel's are opening up

[Michele]

once the new president gets in there   

That is music to my ears!  I just keep re-reading that part of the sentence over and over!

Aaaaahhhhhhhhhhhhh.

[DMK]

Ditto that!!!

I agree that we need to have a healthcare discussion, but it's not free to provide healthcare so why should it be free to receive it?!?

A good friend of ours and a Chiropractor as well has opted out of Medicare because he's so concerned about an audit and/or being fined.  Many chiropractors are switching to cash only.

[PMRNC]

A good friend of ours and a Chiropractor as well has opted out of Medicare because he's so concerned about an audit and/or being fined.  Many chiropractors are switching to cash only.

I'm mainly been dealing with just provider's who are standing on principal alone.. in some of the one's I've been working with the providers cannot really afford to get out of Medicare but against my advice a couple of them still wanted out. I'm doing full analysis to be able to see which provider's could get away with it or not. It's a double edge sword, but the fact that many doctors are willing to risk their reimbursement's to make a stand against the President and this healthcare bill, really says a lot. NOW with this debt ceiling crisis, if you notice in the deal they just struck, and are expected to vote on today.. read it carefully and you will see they note that Medicare beneficiaries won't be harmed, however physicians and insurance companies will feel the crunch.. WELL duh, you idiots in Washington, you go messing with the doctors and the insurance carrier's, you most CERTAINLY are messing with beneficiaries..These are the idiot's in our govt who obviously have NEVER sat in on an economics class in their life!!  BEND over because more change is coming.