Billing > Billing

Billing Secondary

<< < (2/2)

Pay_My_Claims:
there are 2 questions, and i agree, one problem is with the system he uses or as you said a data entry problem.
my post relates to the adjustments. we discussed this before, but if you are par with more than one payor, the contracted rate varies per payor, so there are times where you have to adjust balances if the 2ndary allowable is higher than the primary and they pay more than what is left over by the primary. This is why i don't do adjustments unless there is no secondary to file. The receive the EOB and will pay what is required.

PMRNC:

--- Quote ---This is why i don't do adjustments unless there is no secondary to file. The receive the EOB and will pay what is required.
--- End quote ---

Not sure I follow. If you have a contractual adjustment why don't you enter it? I'm not understanding maybe.

Pay_My_Claims:
yes the contract is we can't bill the balance to the client, but doesn't have anything to do with what we bill to the secondary. Its just easier for me
I have had often secondary's that pay  more than the primary. Aetna has low reimbursements. Aetna pays primary on a k0005 900.00 (200 deductible)We bill 2200 if we are in network we accept the allowable and don't balance bill the client. Medicare is 2ndary and allows 1941.20 Medicare will look at what they would have allowed as primary, what the secondary paid, and calculate what is less. They will pay the difference. If I posted the 900 and adjusted off the balance minus the deductible, I bill Medicare only 200.00 This means if medicare pays the difference of 1041.20 I have to change the allowables or else i have a credit balance. What I do is post the 900 (200 is the deductible) and the balance of 1100 drops to medicare. Medicare makes its payment minus the clients 20%. As longs as I don't bill the client MORE than what is left over after Medicare I have not violated any contractural obligations.

PMRNC:
I'm still confused. Your contractual adjustment is the contractual adjustment. For example if I bill Aetna $100 and the fee schedule is $80, $20 is the contractual obligation and should be entered at the time the payment of the primary is posted. Going back to do contractual adjustments seems counter productive.

Pay_My_Claims:

--- Quote from: PMRNC on December 29, 2009, 02:48:46 PM ---I'm still confused. Your contractual adjustment is the contractual adjustment. For example if I bill Aetna $100 and the fee schedule is $80, $20 is the contractual obligation and should be entered at the time the payment of the primary is posted. Going back to do contractual adjustments seems counter productive.

--- End quote ---

You don't follow...........I don't go back because I don't do the adjustment. What do you do when your secondary pays more than your primary did???
What do you do when you bill 100.00 and INS #! allows 60.00 and pays 40.00 ($20.00 copay).......and the secondary allows 80.00 and pays @ 100% they allow 80-40 from previous payor and they pay you $40.00 When you adjusted off the primary (billed 100, allowed 60 paid 40, you adjusted off 40.00 balance 20.00) now you have to post a payment of 40.00???

Navigation

[0] Message Index

[*] Previous page