Author Topic: Medicare Billing ???  (Read 1039 times)

AllAboutU

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Medicare Billing ???
« on: May 12, 2014, 09:20:59 PM »
Hi yall,

I have never billed Medicare before. How do I know if Medicare is Prime or Secondary? Also, I see the prev biller was submitting Medicare and BCBS, AARP, and BCBS claims for members together to Medicare. For instance, the Medicare and AARP claim for patient A was together, for B it was Medicare and BCBS folded in half and mailed to Medicare. I have googled this same ? and can not find anything. I am familiar with Medicaid billing only. I am working on getting this practice set up to do electronic claims, however, we are sending paper claims for Medicare only at the moment until Novitas processes their paperwork. I am in Texas if that helps. Thanks

PMRNC

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Re: Medicare Billing ???
« Reply #1 on: May 13, 2014, 12:24:47 PM »
I would guess that more than 80% of cases of COB are already established as either Medicare Primary or Secondary. Best initial way to determine is patient to give you both carriers info and you can usually establish the primary payor if the patient doesn't know or it's not on file by calling Medicare. Generally determination goes by the following: (Quickie mini crash course)

Person eligibile for  Medicare because they are 65 or older, their employer insurance is primary to Medicare if they or their spouse is currently working and there are 20 or more employees at the company where they or spouse work.

Person eligible for Medicare because they are  65 or older, their employer insurance is secondary to Medicare if there are fewer than 20 people at the company where they or spouse work.

Person  eligible for Medicare because of a disability, their employer insurance is primary to Medicare if they or their spouse, or other family member is currently working and there are 100 or more employees at the company where they or their spouse or other family member work.

Person eligible for Medicare because of a disability, their employer insurance is secondary to Medicare if there are fewer than 100 people at the company where they or, their spouse or other family member work.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Merry

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Re: Medicare Billing ???
« Reply #2 on: May 13, 2014, 02:36:43 PM »
When the patient has a Medigap policy, Medicare should have that in their master file.. Like Medicare and AARP and it will cross over automatically as long as the provider is par with
Medicare.  One claim to Medicare will take care of both.  When the person has a supplemental policy, perhaps from employer, then Medicare has to be billed and the secondary is billed after Medicare pays.  I would suggest that you make sure that you have copies of the front and back of the insurance card.
You may be interested in our Medicare course.  I think it will help you.  I am sending you the link for the entire course but you can purchase each course separately. www. medicalbillingstudycourse.com
Here is my concern.  If you don't bill correctly, there are sanctions for both you and the provider. You REALLY need to know the ins and out of Medicare and it will help you with all your billing as they set  the standards for most all insurance companies. Good luck.  Hope this helps along with the info from Linda.


shanbull

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Re: Medicare Billing ???
« Reply #3 on: May 14, 2014, 09:10:19 AM »
Quote
You REALLY need to know the ins and out of Medicare and it will help you with all your billing as they set  the standards for most all insurance companies.

Agreed, it's tricky to get everything down in your head to begin with, but once it's there you'll be extremely glad you understand it because whatever Medicare does, every other insurer eventually tends to do it as well. Depending on what specialties you're going to bill for, you may want to review changes in coding and policy over the past year or two as some specialties (PT and OT for example) have special Medicare-specific claim requirements that seem very complicated initially but do make a lot of sense.

AllAboutU

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Re: Medicare Billing ???
« Reply #4 on: May 14, 2014, 09:29:17 PM »
THANKS!!!

I will be looking into the course this weekend. I have been reading up on the changes that have occurred with the new forms. They have been billing Medicare and attaching the secondary claim for Medicare to forward. I didn't think insurances mailed claims for the provider... who knew lol