Author Topic: Medicare Primary question  (Read 571 times)

williamportor

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Medicare Primary question
« on: March 17, 2018, 06:25:18 AM »
This is an odd one. I'm doing billing for an LMT who says he's not credentialed in Medicare. This provider has a patient with Medicare primary and Blue Cross secondary ins. This provider told me to submit claims to Medicare, then simply bill the secondary insurance (Blue Cross) stating Medicare has not paid anything on this claim. This doesn't sound right to me, with no Medicare EOB, they'll be no documentation proving I sent anything to Medicare, and I'm even thinking there may be a legal issue with this. Any suggestions?

PMRNC

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Re: Medicare Primary question
« Reply #1 on: March 18, 2018, 02:36:55 PM »
Quote
This provider told me to submit claims to Medicare, then simply bill the secondary insurance (Blue Cross) stating Medicare has not paid anything on this claim.

Nope, your right it doesn't "sound" right because it is not right. In fact I wouldn't even call this abuse but rather borderline blantant fraud..add a few years in jail more if they want you to submit phony Medicare EOB's with primary payment. HOW do they expect the secondary to consider the primary by you just saying "Oh hey, Medicare didn't pay this so will you please pay it?"

Linda Walker
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Michele

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Re: Medicare Primary question
« Reply #2 on: March 19, 2018, 06:56:25 AM »
Since Medicare does not credential LMTs you cannot submit the claim to Medicare.  They won't process it.  So there is no way to get an EOB from Medicare.   So you are right, you can't submit it to Medicare to get an EOB.  And you can't submit to the secondary stating you submitted to Medicare. 

However, IF the secondary does allow LMTs to submit claims you can contact them to ask them if they will cover it in this situation with Medicare prime.  The reason I say this is because we bill for an Acupuncturist.  Medicare does not credential them either.  We do have patients with secondary plans that allow acupuncture and the claims are billed with the GY modifier and they pay.  The claims are not submitted to Medicare since the secondary insurance carrier (UHC - Empire Plan) knows that Medicare doesn't cover acupuncture and doesn't credential acupuncturists.  But Linda is right, you have to be careful.  You cannot do anything to 'trick' the secondary into paying.  Prior to seeing the patient a call should be made to see if the secondary will allow and how they handle it.
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PMRNC

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Re: Medicare Primary question
« Reply #3 on: March 19, 2018, 07:53:19 AM »
I missed that it was an LMT.. sorry!!  I've heard of others getting a letter from Medicare since they don't cover LMT's the problem however is that most secondaries follow Medicare rules.
Linda Walker
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Michele

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Re: Medicare Primary question
« Reply #4 on: March 19, 2018, 08:17:35 AM »
Exactly, that's why they should definitely contact the secondary BEFORE seeing the patient!   ;D
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PMRNC

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Re: Medicare Primary question
« Reply #5 on: March 19, 2018, 09:51:56 AM »
I've had so many opportunities to bill for LMT's out here but I always refer them out because of that.
Linda Walker
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Michele

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Re: Medicare Primary question
« Reply #6 on: March 20, 2018, 08:51:32 AM »
We used to bill WC and NF for several here in NY.  We actually gave them up because they didn't understand that it took time to get the money.  They want to be paid when they give the therapy and that isn't possible. 
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williamportor

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Re: Medicare Primary question
« Reply #7 on: March 21, 2018, 10:33:47 AM »
Since Medicare does not credential LMTs you cannot submit the claim to Medicare.  They won't process it.  So there is no way to get an EOB from Medicare.   So you are right, you can't submit it to Medicare to get an EOB.  And you can't submit to the secondary stating you submitted to Medicare. 

However, IF the secondary does allow LMTs to submit claims you can contact them to ask them if they will cover it in this situation with Medicare prime.  The reason I say this is because we bill for an Acupuncturist.  Medicare does not credential them either.  We do have patients with secondary plans that allow acupuncture and the claims are billed with the GY modifier and they pay.  The claims are not submitted to Medicare since the secondary insurance carrier (UHC - Empire Plan) knows that Medicare doesn't cover acupuncture and doesn't credential acupuncturists.  But Linda is right, you have to be careful.  You cannot do anything to 'trick' the secondary into paying.  Prior to seeing the patient a call should be made to see if the secondary will allow and how they handle it.



Thank You folks...good idea on calling the secondary insurance. I'll tell the provider, he's only vaguely aware how to do this, so I'm sure it will be news to him too.  :)