Author Topic: INS VS PT BILLING  (Read 2773 times)

rdmoore2003

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INS VS PT BILLING
« on: August 01, 2013, 02:42:53 PM »
I have an issue that I have never encountered before, so please help... I have a patient that has medicare and a supplement.  (my system only holds 2 insurances)  We have been getting denials from medicare because medicare has on file a workers comp. claim, an auto claim, supplement and blue cross.  The patient needs to contact medicare with coordination of benefits.  patient will not even call our office back.  So, of course our claims have nothing to do with w/c nor auto claim.  Medicare is denying because of no coordination of benefits, however we are getting the medicare copays from supplemental and 3rd policy (bc/bs).  The amounts from medicare are not being paid and again patient refuses to return our calls for us to help him with this issue (he has speach difficulties).  So what should I do?  Would this fall under a collections issue?  Should I go back and figure the allowed amounts with medicare and send invoices on that, then collections.  Please Help.
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dekenn

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Re: INS VS PT BILLING
« Reply #1 on: August 01, 2013, 02:56:14 PM »
My first step with patients that won't return phone calls is to send them a bill with the amount due and explain why they're getting the bill. "Medicare won't process this because you haven't contacted them about coordination of benefits. Please call them as soon as possible to straighten this out". I keep a copy too, to document that I tried contacting them. That usually gets the ball rolling!

If Medicare is denying it, why are they forwarding it to the supplementals... and if Medicare denies it, why are the supplements paying??? THAT is unusual!

rdmoore2003

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Re: INS VS PT BILLING
« Reply #2 on: August 01, 2013, 03:11:37 PM »
I have sent the invoice with information that they must contact insurance.  Medicare is not sending to the supplement so I have no idea how supplements are getting the claims. I got a payment from one of them today.  I have not sent them and the patient is not able to send because he doesnt know his name half the time....  THIS ENTIRE SITUATION IS WEIRD.....
Regina

RichardP

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Re: INS VS PT BILLING
« Reply #3 on: August 02, 2013, 03:08:11 AM »
We have some situations where Medicare is primary and won't pay what is being billed, but the secondary will.  But the secondary requires us to bill Medicare, get an EOB from Medicare that says payment is denied, and then send that denial EOB to the secondary before they will pay.  Is that maybe what is going on here - maybe you are supposed to bill the secondary for the charges, accompanied by the denial from Medicare?

rdmoore2003

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Re: INS VS PT BILLING
« Reply #4 on: August 02, 2013, 08:57:41 AM »
I bill medicare.  medicare denies because patient has not contacted them for coordination of benefits.  I then get the copay from the secondary.  since patient is not contacting medicare for coordination, do i bill the patient for the medicare allowed, then send to collections?  It is a odd situation that I am receiving the copays from the secondary...
Regina

PMRNC

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Re: INS VS PT BILLING
« Reply #5 on: August 02, 2013, 09:19:41 AM »
Quote
We have been getting denials from medicare because medicare has on file a workers comp. claim, an auto claim, supplement and blue cross.

You had mentioned other carriers.. it might be a problem of the patient being OVER insured. It happens. It could be that Medicare has to have additional information on the bc not the supplement?   I'm just guessing. 
Linda Walker
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rdmoore2003

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Re: INS VS PT BILLING
« Reply #6 on: August 05, 2013, 02:51:38 PM »
this entire situation has dumbfounded me.  The patient is over insured but our claims have nothing to do with wc or auto claim.   bottom line is the patient is not contacting medicare to coordinate so really my question is to mark each visit with medicare allowed amount and bill patient that amount?  The claims will not be processed correctly if coordination is not done so pt is responsible, right?   
Regina

PMRNC

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Re: INS VS PT BILLING
« Reply #7 on: August 05, 2013, 02:58:05 PM »
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this entire situation has dumbfounded me.  The patient is over insured but our claims have nothing to do with wc or auto claim.   bottom line is the patient is not contacting medicare to coordinate so really my question is to mark each visit with medicare allowed amount and bill patient that amount?  The claims will not be processed correctly if coordination is not done so pt is responsible, right?   

I would say so. I certainly would bill them accordingly but include a note that Medicare is awaiting additional information. I've done it with other carriers regarding COB coverage, even if we are par we need to be paid and if carrier is holding up because of info they need from the claimant/insured.. stands to reason we could "bump" it along with reminders. Now whether it's "collectable" becomes another story.
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Merry

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Re: INS VS PT BILLING
« Reply #8 on: August 05, 2013, 05:47:46 PM »
From a legal standpoint..and I am not an attorney but familiar with this situation.
It is solely the patient's responsibility to inform Medicare of any changes in their insurance. It is a MEDICARE PROCESS and a patient can be legally held responsible for any charges not reimbursed because the information on file is not current or correct. You need to inform the patient that they need to call Medicare and I would also tell them that if this is not handled within a certain time period, then they will be responsible for the charges that are not paid. The patient is responsible for making sure that their information at Medicare or any other insurance company is correct.

rdmoore2003

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Re: INS VS PT BILLING
« Reply #9 on: September 27, 2013, 11:15:14 AM »
Here is an update on this topic.   The patient contacted his old workers comp carrier trying to demand for them to pay his bill....funny right.  Workers comp told him that he has to do the same thing I have been telling him,  you must contact medicare to do your coordination of benefits.... so after 6 months, he finally did it.   I received a call from medicare verifying that he had updated.  They said I must resubmit the claims electronically of course with the statement "not worker comp or auto accident related.   So, my question is should I put that statement in line 19? 
Regina

PMRNC

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Re: INS VS PT BILLING
« Reply #10 on: September 27, 2013, 11:46:46 AM »
Quote
Here is an update on this topic.   The patient contacted his old workers comp carrier trying to demand for them to pay his bill....funny right.  Workers comp told him that he has to do the same thing I have been telling him,  you must contact medicare to do your coordination of benefits.... so after 6 months, he finally did it.   I received a call from medicare verifying that he had updated.  They said I must resubmit the claims electronically of course with the statement "not worker comp or auto accident related.   So, my question is should I put that statement in line 19?

My answer might be different from others..but I would actually do a paper claim with letter and documentation of the call from Medicare.
Linda Walker
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shanbull

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Re: INS VS PT BILLING
« Reply #11 on: September 27, 2013, 04:33:27 PM »
Here is an update on this topic.   The patient contacted his old workers comp carrier trying to demand for them to pay his bill....funny right.  Workers comp told him that he has to do the same thing I have been telling him,  you must contact medicare to do your coordination of benefits.... so after 6 months, he finally did it.   I received a call from medicare verifying that he had updated.  They said I must resubmit the claims electronically of course with the statement "not worker comp or auto accident related.   So, my question is should I put that statement in line 19?

No one actually reads the electronic claims on the first pass. The decision is made by software. So stick it in line 19 but expect it to be rejected because there's no human on the other end to read it. Have an appeal form ready to go with letters denying liability from the auto and worker's comp policies (you will need to contact those companies and request them). You shouldn't have any problems with getting paid after that, I do it all the time (I work for a chiropractic/PT clinic so we have to deal with this a lot).