Medical Billing Forum

Billing => Facility Billing => Topic started by: PsychBiller on July 12, 2012, 12:44:28 PM

Title: Patient did not disclose that they had Medicare Part B
Post by: PsychBiller on July 12, 2012, 12:44:28 PM
A patient was seen in our office earlier this week and paid out of pocket as they stated that they did not have insurance.  Today they have called and said that they have Medicare Part B.  Am I legally obligated to refund the patient their money and file the claim with Medicare?
Title: Re: Patient did not disclose that they had Medicare Part B
Post by: PMRNC on July 12, 2012, 12:46:09 PM
I'm not sure legally since they didn't give you the information when they should have, however I would think to avoid a headache later it is probably the better solution to refund them and file the claim as normal.
Title: Re: Patient did not disclose that they had Medicare Part B
Post by: DMK on July 12, 2012, 01:07:01 PM
Get the information and file the claim (check if they have supplemental too!).  After all insurance has paid (or not) refund the difference. 
Title: Re: Patient did not disclose that they had Medicare Part B
Post by: PMRNC on July 12, 2012, 01:45:27 PM
Quote
Get the information and file the claim (check if they have supplemental too!).  After all insurance has paid (or not) refund the difference. 

I don't think that would fly now since they now know Medicare is in the picture.. Once they knew about it they were obligated anyway to file claim..They could request all but the copay I supppose
Title: Re: Patient did not disclose that they had Medicare Part B
Post by: DMK on July 13, 2012, 10:13:01 AM
But if the patient hasn't met their Medicare deductible, and if they don't have a secondary or supplemental, OR they bill correctly with the correct modifiers for the services performed (covered vs. non-covered) at least the patient has paid toward the anticipated patient portion.  I understand they will absolutely have to refund the monies the patient does not owe.

I also see your point regarding an immediate refund, but sometimes it's hard to get the patient to pay the 1st time, let alone a second time! JMO.
Title: Re: Patient did not disclose that they had Medicare Part B
Post by: PMRNC on July 13, 2012, 05:07:34 PM
Yeah I see your point too.  So long as the claim is filed I don't see a problem with either scenario ;)