Author Topic: Help  (Read 1755 times)

Charles

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Help
« on: July 16, 2009, 04:58:27 PM »
Help ???

I just got a letter from an insurance company asking to return funds for a claim that was supposed to have been billed to Medicare.  I billed Medicare and I want to reimburse the Medicare amount and not the full amount but the insurance company wants the full amount and then submit a claim for a secondary.

Any advice?

Thanks

Pay_My_Claims

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Re: Help
« Reply #1 on: July 16, 2009, 06:00:55 PM »
You have to refund the full amount(that they paid). If you don't they will RECOUP the money.

PMRNC

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Re: Help
« Reply #2 on: July 16, 2009, 06:14:45 PM »
Charlene is right, what they will do is back out the previous claim and re-process it as secondary.
You have to refund the full amount.
Linda Walker
Practice Managers Resource & Networking Community
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Charles

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Re: Help
« Reply #3 on: August 04, 2009, 12:34:52 PM »
Thank you.

Steve Verno CMBS, CEMCS

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Re: Help
« Reply #4 on: August 08, 2009, 09:22:06 AM »
I agree about returning the full amount.  but I do things a little differently that may not work for others.

if my doctor is contracted, I return any amount that is over the contract payment amount.  If my doctor is not contracted, I return the amount over the carrier's usual and customary fee. 

Any money I return is sent with an accompaning letter describing the amount being returned.

If the insurance company says Medicare is primary, I demand they provide me with verifiable proof.  I also inform them they cannot offset or take back any funds without our written permission (This is in our state refund law). 

Now, if they just want their money back for a fivolous reason, i write to the CEO,  I inform him, we have outstanding claims and I am more than happy to do as they do by offsetting an unpaid claim against their request.  Yes, this can be a numbers nightmare but at least I keep the money instead of giving it back and begging for the money for the unpaid claim.  I did check with my State Insurance Commissioner about doing this and he said there is nothing in our state law that says we cant do this as long as I give the insurance company the same ability to say no like we can. Some agree and some dont but at least I gave it a try.
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PMRNC

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Re: Help
« Reply #5 on: August 08, 2009, 09:37:02 AM »
Ha .. I knew it was you steve.. LOL

We have different opinion on this. When the carriers do adjustments, the easiest and fastest way to do it is by backing the claim out (like it never was processed) and reprocessing it. The more hassle you make of it, the more time it takes. I have tried the fight and hold method and it's just quicker and easier on the bottom line to comply and let them re-process. But yes I agree you should be sure the money is first owed.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Pay_My_Claims

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Re: Help
« Reply #6 on: August 08, 2009, 05:39:53 PM »
Linda I figured it was him too, but didn't say his name in the post. I knew for certain on another post. His style is very unique.