Author Topic: Medicare...  (Read 1445 times)

KathyG

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Medicare...
« on: April 09, 2012, 11:21:24 AM »
I recently started handling billings for a physician who has never accepted insurance or Medicare.  He recently became an in-network provider for Aetna.  He just saw a client for the first time, who presented him with his Aetna card; however, I discovered it is secondary to Medicare.  Since none of the physicians I have billed for in the past have accepted Medicare or Medicaid, I don't know if there is a way around this if he hasn't enrolled in Medicare.  I did notice there's a form that the patient can complete, if he pays the physician up front and submits the form and bill to Medicare.  Could anyone tell me if the use of this form applies if the physician is not enrolled in Medicare?

Thank you.

KathyG

Michele

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Re: Medicare...
« Reply #1 on: April 10, 2012, 09:39:09 AM »
If the physician is not enrolled in Medicare he is not supposed to treat Medicare patients.  Even if the patient has Aetna secondary, I believe they are supposed to refer the patient to a Medicare provider.
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KathyG

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Re: Medicare...
« Reply #2 on: April 10, 2012, 11:10:51 AM »
Thanks, Michele.  This practitioner, and other solo practitioners I've encountered, have no concept of these things.  As a result, such as in this case where the provider didn't give me any information in advance so that I could look into what coverage and benefits the client had, I seem to spend time putting out fires for them.  (The proper process is in my contract and I've verbally explained it to them).  Very frustrating for me...and they lose money when they fail to verify all the insurance information and get a prior authorization, if required, before they even see the client for the first time.  These are not emergency cases and the information could have been gathered in advance.  Ugh!

Anyway, it says in Medicare's on-line handbook that people can have a "private contract" with a provider.  So, apparently, they can pay the provider's full fee themselves, but not too many people would be willing to do that and, of course, it would eliminate any secondary coverage they might have. 

amygarside

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Re: Medicare...
« Reply #3 on: May 18, 2012, 04:22:32 AM »
I think practitioners should be aware of this, as it truly is frustrating and a waste of time and effort on our part.

cconter

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Re: Medicare...
« Reply #4 on: June 08, 2012, 05:04:31 AM »
I had a similar situation in my office.  Doctor had "opted out" of Medicare.  Patient came in with UHC secondary to Medicare.  I contacted both Medicare & UHC for instruction.  This is what I was told by both:

If doctor formally opted-out, send a copy of opt-out letter with claim directly to secondary carrier.

If doctor is not enrolled in Medicare, send claim to Medicare for denial, then submit claim w/Medicare's EOB to secondary.    Be sure to have a valid ABN on file and include GY modifiers on claim accordingly.

Hope this helps!