Author Topic: Medicare Secondary  (Read 3567 times)

cconter

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Medicare Secondary
« on: April 14, 2010, 04:55:01 PM »
Hello,  After 21 years with the same doctor, we have our FIRST patient with secondary coverage thru Medicare.  I'm a little confused about CMS1500 completion.  Specifically 11(d).   Info I found online says an answer is "optional".  I find this hard to believe.  Anyone have any experience?  Thanks!

Yesica

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Re: Medicare Secondary
« Reply #1 on: April 14, 2010, 05:43:15 PM »
We have patients that have Medicare as secondaries and you do need to add in the primary insurance or else they will deny claim.

DMK

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Re: Medicare Secondary
« Reply #2 on: April 14, 2010, 06:36:36 PM »
Treat Medicare as you would any other secondary.  I don't know your specialty but be sure to use the appropriate Medicare modifiers and diagnosis systems AS IF you were billing Medicare as primary. 

Michele

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Re: Medicare Secondary
« Reply #3 on: April 14, 2010, 09:00:15 PM »
When we file claims with Medicare secondary, we do indicate other insurance by checking box 11d.

Michele
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cconter

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Re: Medicare Secondary
« Reply #4 on: April 15, 2010, 06:12:26 AM »
Thanks all!

dekenn

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Re: Medicare Secondary
« Reply #5 on: April 15, 2010, 08:36:07 AM »
Also remember that Medicare no longer accepts consults.  If this is a consult, you need to change the code before submitting it to Medicare. ;)

blhoffman

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Re: Medicare Secondary
« Reply #6 on: April 15, 2010, 09:34:27 AM »
dekenn, I'm not sure what you mean? If they did a consult - then its a consult, whether Medicare pays for them or not. Change the code?

DMK

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Re: Medicare Secondary
« Reply #7 on: April 15, 2010, 10:42:41 AM »
You can't change the codes between billing primary to billing secondary.  The claim is the claim, the services are the services.  Even if Medicare doesn't pay consults, the primary should UNLESS the primary only pays services normally allowed by Medicare.

Here's an example from our Chiropractic office:

Primary is Blue Cross - patient has massage therapy, chiropractic adjustment, mechanical traction.  Since Medicare is the Secondary I bill the services with the appropriate Medicare modifiers and make sure the diagnosis conforms with Medicare LCDs.  Blue Cross pays their portion for their covered services.

The claim gets sent to Medicare for their portion.  They do not pay for anything other than the chiropractic adjustment, and since I used the appropriate modifiers showing that the patient and I know the other services were not allowed I can collect any deductible or co-pays not covered by the primary for the other services.

If you don't use the right modifiers from the start, you can't collect for Medicare's non covered services.


dekenn

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Re: Medicare Secondary
« Reply #8 on: April 16, 2010, 09:05:29 AM »
Actually, you can change the claim when the primary insurance recognizes the consultation codes and the patient has medicare as a secondary. 

http://www.cms.gov/ContractorLearningResources/downloads/JA1010.pdf

On page 4, it answers the question on how to deal the medicare as a secondary. (Sorry, I'm not very computer savvy, don't know how to add a "link", so I had to copy and paste the address   ;)  )

This is just new for 2010 because of Medicare eliminating the consultation codes.

dekenn

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Re: Medicare Secondary
« Reply #9 on: April 16, 2010, 09:08:20 AM »
Never mind about the "link" thing.... it did it for me!!! How do you get the smiley faces though?

blhoffman

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Re: Medicare Secondary
« Reply #10 on: April 16, 2010, 10:02:32 AM »
Found it on page 4 of that address. Very good information to know. I'm printing it out to read when I have more time. Yeah, I love this kind of stuff.

Michele

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Re: Medicare Secondary
« Reply #11 on: April 16, 2010, 10:15:25 AM »
 :D  :)  ;D  8)  ::)  :)  :D  ;D
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Pay_My_Claims

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Re: Medicare Secondary
« Reply #12 on: April 16, 2010, 11:26:37 AM »

Michele

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Re: Medicare Secondary
« Reply #13 on: April 16, 2010, 02:04:43 PM »
Sorry, but I couldn't resist.  It's my forum and it actually took me a while to figure out how to get them, then when I did, it was so easy I couldn't believe it took me so long!  LOL at myself!
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Pay_My_Claims

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Re: Medicare Secondary
« Reply #14 on: April 16, 2010, 02:05:55 PM »
OMGeeeeezy