Author Topic: Billing secondary payer after Medicare  (Read 1920 times)

wforal

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Billing secondary payer after Medicare
« on: June 21, 2013, 11:54:40 AM »
Since a supervising physician is not required when billing an NP claim to Medicare, how do I bill the secondary payer if they don't contract with NP's?

Merry

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Re: Billing secondary payer after Medicare
« Reply #1 on: June 21, 2013, 09:56:19 PM »
IS the secondary a supplemental or a Medigap plan? I imagine you are talking about a supplemental since it would not be a problem with Medigap policy as long as Medicare has paid the claim.

I'll leave this one for Linda. She has that expertise. I am the Medicare person.

PMRNC

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Re: Billing secondary payer after Medicare
« Reply #2 on: June 22, 2013, 07:58:08 AM »
Quote
Since a supervising physician is not required when billing an NP claim to Medicare, how do I bill the secondary payer if they don't contract with NP's?

That's actually a good darn question..  I'm assuming with the secondary the supervising physician is contracted? I'd say your best bet is to call the secondary and ask them. Since many of the supplemental plans  follows Medicare when denied.. you would think it would be the other way around if they paid  :P ;D  I'd call to find out and if you could post it here so we can learn.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RichardP

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Re: Billing secondary payer after Medicare
« Reply #3 on: June 23, 2013, 04:24:14 PM »
If a supervising physician is not required when billing an NP claim to Medicare, that means the NP has been authorized to bill on his own (otherwise the supervising physician would be the billing entity).  The NP is considered the billing entity, who is qualified to apply to be a participating provider with insurance carriers.

I'm curious if an NP in this situation has the same rights and responsibilities as physicians have in terms of how they are allowed to bill the patient.  That is, our clients who are non-par charge whatever they want to and the patient is obligated to pay.  The insurance carrier cannot run interference for the patient, because the carrier has no contractual relationship with the physician.  I'm curious whether this dynamic extends to NPs - since the issue has come up.

PMRNC

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Re: Billing secondary payer after Medicare
« Reply #4 on: June 24, 2013, 08:37:27 AM »
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I'm curious if an NP in this situation has the same rights and responsibilities as physicians have in terms of how they are allowed to bill the patient.  That is, our clients who are non-par charge whatever they want to and the patient is obligated to pay.  The insurance carrier cannot run interference for the patient, because the carrier has no contractual relationship with the physician.  I'm curious whether this dynamic extends to NPs - since the issue has come up.

Wfoal... congrats you have stumped us all. LOL   I think two elements that has to be known  first before guessing,  is if the provider is par with the secondary, and if that secondary is a supplemental or Medigap policy, if it's a supplemental plan then I would really call the secondary instead of trying to guess because this is an excellent question!! The secondary may not credential the NP or even cover them w/out supervision and supplemental's do not have to pay just because Medicare did like Medigap plans.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RichardP

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Re: Billing secondary payer after Medicare
« Reply #5 on: June 24, 2013, 11:51:37 AM »
I should have made it more clear in my post that my curiousity was about the question(s) as applied to all NPs, not just to this specific instance.  If an NP is qualified to be a billing entity (not all NPs are so qualified) and is billing as the billing entity, and if they are non-par with a carrier, are they free to charge whatever they wish - as a doctor is?  At this point, this is a rhetorical question, not a real question.

Two of our clients have an NP (one for each provider), and I researched the issue of how they could/should bill for their services when they came on board.  Both NPs are qualified to bill on their own, but both are billing under the name of the supervising physician.  Since neither NP is billing on their own, it didn't occur to me while researching the issue to find the answer asked in my first paragraph above.