Author Topic: Medicare  (Read 1500 times)

dmp001

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Medicare
« on: September 23, 2013, 12:41:12 PM »
Hello, I'm writing in regards to Medicare denial CO22 and CO109.  When Medicare denies for these codes, we generally try to locate the other coverage that is eligible, however, sometimes we are not able to find the insurance information. Since we aren't suppose to bill the patient, our billing office sends a letter to the patient requesting them to supply us with the information.  Most times, they do not respond back with their insurance information.  And if we contact them by phone call, no answer most of the time.  So, does anyone know if we are able to bill the patient after we exhaust our attempts, or do we have to write off as uncollectible?  I feel that the patient should be accountable for the claim, however, because Medicare indicates it as "contractual obligation", we end up writing off.  Or does Medicare has disclaimers that we can file back to them with?  Any help would be greatly appreciated! :)

DMK

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Re: Medicare
« Reply #1 on: September 23, 2013, 01:05:54 PM »
It is up to the patient to provide the correct insurance information.  If they don't, you can send them the bill with a note "we will be happy to bill your CORRECT insurance provider, otherwise this bill is your responsibility".  That usually gets us a response "hey, here's the correct information, the insurance company should pay this". 

It's a good idea to really train the front desk to be sure to get ALL the insurance cards and to verify benefits immediately.  That way there's no time lag, and the patient knows right up front what, if anything, they will owe.

dmp001

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Re: Medicare
« Reply #2 on: September 23, 2013, 01:17:05 PM »
That's exactly what I would think too!  The problem with us, is that we are third-party billing for ER physicians, so we try to reiterate to the Drs. that whoever is working the front desk at the hospital, really needs to be more accurate with information being obtained from the patient.  However, it just doesn't seem to matter.  We then get stuck doing the work and for some reason, the office manager feels we have to write-off when the patient neglects to provide us with information after several attempts.  Thanks much for your feedback DMK!  :)

DMK

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Re: Medicare
« Reply #3 on: September 23, 2013, 01:56:03 PM »
Your area's Medicare processor should have a web site that can be accessed to verify pertinent coverage information.  It would be in your best interest to get set up with them FOR the ER Doctor's so you can get as much information as possible.  With the patient's MC ID# you'll be able to see who their secondary (or replacement plan) is. 

The only downside is that it is only as updated as the patient keeps it.  We have several patients who never tell Medicare who their secondary is, so we have to bill them instead of the claim crossing over.

The replacement plans are causing us a larger problem.  The patient's don't even seem to know how they work, so it takes me a little time to figure them out.

dmp001

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Re: Medicare
« Reply #4 on: September 24, 2013, 07:50:48 AM »
Yes, we do have access to the Medicare portal, however, like you mention, if the patient doesn't update with Medicare, our hands are tied.  I agree with you that the managed care programs are a pain  :-\    But at least Medicare will provide us with the managed care, however, too bad they don't provide us with the ID#s!  I know, that's too much to ask for!! lol, Thanks much for your feedback!