Billing Secondary for LPC, When Medicare is Primary

[mpl]

This is my first time asking a question. I love this forum and use it A LOT. I hope that this isn't a repeat, but I haven't found an answer yet and hope that someone can point me in the right direction.

I bill for Mental Health and Substance Abuse providers in WI. One of my providers is an LPC and sees a client who has Medicare as their primary and Dean Medicaid as their secondary. Another provider (also an LPC) sees a client with Medicare as primary and iCare Medicaid as secondary. I've not had problems in the past just billing directly to the secondary insurance, but am starting to get denials coming back from both Dean and iCare requiring that I have a Medicare denial attached to the claim. Since I can't submit to Medicare because an LPC isn't eligible to be a Medicare provider, I can't provide them with this. I've contacted both Dean and iCare to explain this, but neither of them are budging. Initially iCare told me that I needed to put 'M8' in box 11 of the HCFA form. I did this and some claims paid, but others did not. On top of it, iCare has now recouped several claims that they had previously paid, insisting that it has to be billed to Medicare first.   

Another biller who I've worked with passed along a Medicare letter to me (see attached document). She said she will sometimes attach a copy of it to the claim and that usually works to get the claim paid. I've tried locating this document on the Medicare website in hopes of having a more updated (and cleaner, easier to read) version of it so I can use it for citing, but cannot find it.

So two questions....
1. Is there a code or modifier or something that I'm supposed to be putting on the HCFA to flag it to indicate that the Medicare policy can be bypassed due to the provider's credentialing?
2. Does anyone else know where I can find the Medicare letter?

ANY help would be greatly appreciated. Thanks so much!!

[Michele]

So two questions....
1. Is there a code or modifier or something that I'm supposed to be putting on the HCFA to flag it to indicate that the Medicare policy can be bypassed due to the provider's credentialing?

Have you tried the GY modifier? 

GY  -  Item or service statutorily excluded or does not meet the definition of any Medicare benefit.

We use that when we bill a commercial carrier for acupuncture since acupuncture is not a covered Medicare benefit.

2. Does anyone else know where I can find the Medicare letter?

ANY help would be greatly appreciated. Thanks so much!!

There was no attachment.  I don't believe there is a way to include an attachment on the forum.  I'm not familiar with the letter you are referring to.  Does the other biller have a copy you can just use? 

The only other thing I can recommend is printing out the copy of the page from the CMS 855I that shows the types of providers that Medicare will enroll with a letter stating that LPCs cannot enroll in Medicare therefore claim cannot be submitted to Medicare.

I hope that helps!  Keep us posted.

[mpl]

I haven't tried that modifier. Is that something that can be used to indicate that the service is typically an allowable Medicare service, but the provider isn't participating, so that's why it isn't allowable in this circumstance? I'm using CPT code 90837.

Sorry about the confusion on the attachment...I meant to take that out of the post. I had initially tried attaching it, but it wouldn't attach. I do have a copy of the letter from the other biller, but it's pretty old and almost to the point of being difficult to read. I was hoping to find something that had a specific date on it as well, to show that it was up to date. I'll probably just use what I've been given and add a copy of the list of providers who can't enroll in Medicare.

[Michele]

I am not aware of a modifier that specifically says "provider is not allowed".  That is the closest modifier I know of.  That is what we use for the acupuncturist we bill for.

[mainiaDup]

Therefore, the take home message is as Dr <a href=http://priligy.me/>what is priligy dapoxetine</a>

[jossibe]

ICI 182, 780 was kindly provided by Dr <a href=https://stromectol.ink/>stromectol for pinworms</a> Posted on May 11, 2008 05 30PM

[royagma]

<a href=http://lasix.autos/>lasix adverse effects</a> The procedure included a step with DNAse I treatment Applied Biosystems, Foster City, CA, USA

[unorgobug]

We show that tau transgenic flies have an innate biotin deficiency due to tau mediated relaxation of chromatin and consequent aberrant expression of multiple biotin related genes, disrupting both carboxylase and mitochondrial function <a href=http://doxycycline.world/>can doxycycline treat trichomoniasis</a> revia ibuprofen 400 preis sterreich However in boys, 85 minutes per day of moderate to vigorous physical activity, including around 20 minutes vigorous physical activity, could be necessary to prevent the negative consequences ascribed to clustering of risk factors, the scientists concluded

[awaixebra]

<a href=http://sviagras.cyou>whats viagra</a> com 20 E2 AD 90 20Kpa 20Viagra 20P 20Ntet 20Billigt 20 20Viagra 20Naturala 20Pt 20Barbati viagra naturala pt barbati Nor do they mind jeopardizing the sovereign bond market as a whole possibly other bond markets as well by creating dangerous precedent for special treatment

[Vogegrorb]

<a href=https://clevitras.cyou>viagra o levitra</a> Find out how climate change is contributing to lung cancer around the world

[piegmen]

<a href=http://clomid.one>how much does clomid cost</a> David Heiman, an attorney with Jones Day, the law firm representing Detroit, said while the city would enthusiastically accept the judge sdeadline, it wants to move faster

[Faispom]

<a href=https://priligy.skin>buy priligy 30mg</a> Alternatively, ACTH measurements can be made from venous drainage of the anterior pituitary gland by simultaneous bilateral catheterization of the inferior petrosal sinuses; many regard this as the definitive investigation of Cushing s syndrome

[easetty]

8 for control patients; 95 CI, 1 <a href=http://doxycycline.buzz>doxycycline vs minocycline</a>

[uttessy]

<a href=http://priligy.buzz>Priligy</a> Previously we have demonstrated the good correlation of affinity measured by FTSA, ITC, SFA and surface plasmon resonance 9

[ideorrert]

<a href=https://nolvadex.hair>nolvadex side effects male</a> During present investigation, the effect of papaya extracts from leaves, skin, pulp and seeds were assessed on estrogen and Her 2 dependent and independent breast cancer using representative cells lines