Medical Billing Forum

General Category => General Questions => Topic started by: carflorida on March 11, 2013, 07:27:25 PM

Title: Crossover claim
Post by: carflorida on March 11, 2013, 07:27:25 PM
What is a crossover?
Title: Re: Crossover claim
Post by: RichardP on March 11, 2013, 08:25:24 PM
Crossover pertains to Medicare and supplemental coverage.  When Medicare is primary, and there is a secondary insurance, and Medicare has been made aware of the secondary - the Medicare contractor will forward the claim automatically to the secondary when they are finished processing the claim.  Think of crossover as the automatic billing of the secondary by Medicare.
Title: Re: Crossover claim
Post by: PMRNC on March 12, 2013, 08:51:48 AM
There are some times where a crossover should be in place but it's not, Medicare will tell you it's up to the beneficiary to set up this crossover.  I've run into a few of them, not many though because once it's setup its all good.
Title: Re: Crossover claim
Post by: DMK on March 12, 2013, 11:45:51 AM
It is COMPLETELY up to the patient to set up the crossover with Medicare.  We've run into a lot of patients changing their supplementals frequently, it's a pain.  And they hate to have to call Medicare to set up the correct info.  It's important for the front office to verify the correct insurance info frequently.
Title: Re: Crossover claim
Post by: carflorida on March 14, 2013, 11:09:12 AM
Thanks so much!  :D That was all very helpful.

So the healthcare provider is not responsible for setting up the crossover? It is the patent's?



PS Do I have to type in the verification every time I post?
Title: Re: Crossover claim
Post by: RichardP on March 14, 2013, 11:21:20 AM
So the healthcare provider is not responsible for setting up the crossover? It is the patent's?

Yes.
Title: Re: Crossover claim
Post by: Michele on March 15, 2013, 11:32:20 AM
On the verification, yes, unfortunately do to spammers.
Title: Re: Crossover claim
Post by: K and K Billing on March 22, 2013, 02:59:48 PM
I will disagree that the beneficiary has to set up the crossover with Medicare in all cases - AARP will do that when a person signs up for the AARP Medicare supplement plan. (Personal experience) There may be others that do it also. In NY and CT, the local Medicare contractor has an IVR that will tell you if there is an automatic crossover. They also have a web site to give that information as well as other information.

If a claim is not crossed over then you have to file a paper claim (most cases) with the secondary and include a copy of the primary EOB. You can use the original claim to Medicare, but have to switch the primary and secondary insurers and put the paid amount by Medicare in field 29 of the 1500 form.
Title: Re: Crossover claim
Post by: PMRNC on March 22, 2013, 03:36:46 PM
BOTTOM line is that because of privacy laws.. the beneficiary is ultimately responsible for setup of the cross over.