Author Topic: Medicare Billing Question  (Read 43 times)

avehildebrand

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Medicare Billing Question
« on: September 14, 2018, 01:28:55 PM »
Hello fellow members!!

We currently have a patient who now has Medicare a their primary carrier and we are not taking medicare patients at this time. They called their secondary insurance and were told that we can still submit to the secondary and put on the claim that we do not take medicare and they will process it. I have never heard of this before..If Medicare is the primary it is to my understanding that all claims need to be sent to them first...and if we are not contracted or claims are denied them we will not receive payment.

OR can the claims be denied by Medicare and the secondary cover the services?

Thanks everyone!

Michele

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Re: Medicare Billing Question
« Reply #1 on: September 16, 2018, 06:44:17 PM »
Are you enrolled with Medicare?  As participating or non participating?  Or are you not a Medicare provider at all?  I have always believed that if you are not a Medicare provider then you cannot treat a Medicare patient, unless you are a provider that Medicare does not credential such as an acupuncturist.   If it is a service that is not covered by Medicare (such as acupuncture) then the secondary can be billed without a Medicare EOB and they will pay.
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PMRNC

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Re: Medicare Billing Question
« Reply #2 on: September 17, 2018, 10:03:53 AM »
The only way you can submit to a secondary without the Primary (Medicare) EOB is when the secondary is an INDIVIDUAL plan. (non group, non medicare, non supp or non advantage). Patient must be paying full premium on individual plan.
Linda Walker
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Sriram_Sub

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Re: Medicare Billing Question
« Reply #3 on: September 17, 2018, 11:07:27 AM »
As you are not a Medicare provider at all (or so as I understand), I have a strong doubt if you would even be able to submit a claim electronically as it might get rejected stating "Invalid provider primary identifier".
As the patient was a walk-in and was informed by your office that you don't treat Medicare patients, you may get an ABN signed by the patient, just to be on a safe zone, so that even you find the payers' doors shut, you have the other party to collect the money from.
As many older patients misinterpret (or misunderstand) information given by payers, I would suggest you to call the 2ndary payer yourself to understand how to submit a claim in this situation.

I am curious to know how this might turn out. Please update us when you find a solution. Good luck.
Sriram

Michele

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Re: Medicare Billing Question
« Reply #4 on: September 18, 2018, 06:43:16 AM »
The only way you can submit to a secondary without the Primary (Medicare) EOB is when the secondary is an INDIVIDUAL plan. (non group, non medicare, non supp or non advantage). Patient must be paying full premium on individual plan.

I would agree with this, but we have a provider (acupunture) who is in network with Empire (NYS Employee Health Plan) and when a patient has Medicare prime we don't have to submit to Medicare.  We send straight to Empire and they pay. 

In this business there is always one exception to every rule.  That is what makes it so crazy. 

It is impossible to answer this question without more details.  What type of service?  Is the provider eligible to be credentialed with Medicare but chooses not to?  The original post seemed to indicate the provider may be a Medicare provider but is not accepting any additional Medicare patients at this time??
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