Author Topic: PRIMARY VS SECONDARY COPAYS  (Read 5545 times)

RCLEARH2O

  • Newbie
  • *
  • Posts: 9
PRIMARY VS SECONDARY COPAYS
« on: June 26, 2009, 10:48:21 AM »
I have a question about copays. If a patient has medicare and a secondary insurance (with a $18 copay) shouldn't we be collecting the medicare copay up to the amount of the second copay? Example 99213 = 12.73 medicare copay the patient would pay the medicare copay BUT a 99214 = 19.15 copay so the patient would pay their secodary copay of 18.00?  Basically we should be collecting the medicare copay UP TO the amount of the secondary Copay. Then the secondary pays the balance. Am I correct on this?

Thank you

Robin

Pay_My_Claims

  • Guest
Re: PRIMARY VS SECONDARY COPAYS
« Reply #1 on: June 27, 2009, 12:35:51 PM »
Trick question that can't be answered yes or no. A secondary may or may not cover the Medicare copay/deductible or even coinsurance, so it would depend on what 2ndary you have, regardless if the payment applies to the Medicare copay, then the balance will drop down to the 2ndary and they will coordinate benefits accordingly. EX: Client has Medicare and BCBS-NC SEHP-secondary. They have not met their Medicare copay/deductible. Services billed is 500.00 allowed 400 medicare will deduct 135.00 (copay) and pay 80% of 265.00 $212.00 EOB shows PR= 178.00 This drops to the 2ndary, but they have a 450.00 deductible with their insurance, they haven't met, so they will owe 178.00. If the client had AARP, they would have paid 100% of the deductible and 20% (if they choose that aarp plan). Also if they had met their deductible with SEHP, they would have paid 80% of the 178.00 (minus the copay) and the balance would be the clients. With UHC if the Medicare payment is more than the UHC allowed then no payment is made, so it depends on the various circumstances and what type of plan is secondary

PMRNC

  • Hero Member
  • *****
  • Posts: 4218
    • One Stop Resources & Networking for Medical Billers
Re: PRIMARY VS SECONDARY COPAYS
« Reply #2 on: June 27, 2009, 04:27:36 PM »
Ha ..I was going to say that but was second guessing myself for a moment!
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4709
    • Solutions Medical Billing
Re: PRIMARY VS SECONDARY COPAYS
« Reply #3 on: June 30, 2009, 08:25:45 PM »
In the example they gave the secondary has an $18 copay so I'm assuming a deductible for the secondary would not apply.  However, it still is not an easy 'yes or no' answer.  For example, if the patient came in and Medicare was billed for a 99213 where the 20% patient responsibility would be $12.73 and you collected the $12.73, but then the claim is submitted and the deductible is applied (by Medicare).  Then the secondary processes and applies an $18 copay, but only $12.73 was collected.  Gets sticky.  In my opinion it is generally better to wait on collecting from a Medicare/2ndary patient until processing is complete.

With that being said, I have many Chiros who collect the 20% coinsurance up front when they know the 2ndary either has a larger copay, or it isn't going to pay and it works great for them.

I bet you wish we all said a simple yes or a no!

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

RCLEARH2O

  • Newbie
  • *
  • Posts: 9
Re: PRIMARY VS SECONDARY COPAYS
« Reply #4 on: July 02, 2009, 09:29:45 AM »
THANK YOU!!! I DO WISH IT WAS A SIMPLE YES OR NO. THE ANSWERS WERE WHAT I THOUGHT TO BEGIN WITH I'M JUST ALWAYS SECOND GUESSING MYSELF!

Pay_My_Claims

  • Guest
Re: PRIMARY VS SECONDARY COPAYS
« Reply #5 on: July 02, 2009, 10:01:55 AM »
Trust in your instincts, but there is ABSOLUTELY nothing wrong with double checking!! I do all the time!!

PMRNC

  • Hero Member
  • *****
  • Posts: 4218
    • One Stop Resources & Networking for Medical Billers
Re: PRIMARY VS SECONDARY COPAYS
« Reply #6 on: July 02, 2009, 05:04:31 PM »
My rule of thumb is that if I don't know the answer to something... 99.9% of the time I can get it faster by calling the carrier than I can by researching unless it's something state or federal specific.

2nd to calling the carrier...there's always GOOGLE!!!
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4709
    • Solutions Medical Billing
Re: PRIMARY VS SECONDARY COPAYS
« Reply #7 on: July 02, 2009, 10:24:03 PM »
I love Google!   ;D

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com