Billing > Billing
Medicare Secondary
dekenn:
Also remember that Medicare no longer accepts consults. If this is a consult, you need to change the code before submitting it to Medicare. ;)
blhoffman:
dekenn, I'm not sure what you mean? If they did a consult - then its a consult, whether Medicare pays for them or not. Change the code?
DMK:
You can't change the codes between billing primary to billing secondary. The claim is the claim, the services are the services. Even if Medicare doesn't pay consults, the primary should UNLESS the primary only pays services normally allowed by Medicare.
Here's an example from our Chiropractic office:
Primary is Blue Cross - patient has massage therapy, chiropractic adjustment, mechanical traction. Since Medicare is the Secondary I bill the services with the appropriate Medicare modifiers and make sure the diagnosis conforms with Medicare LCDs. Blue Cross pays their portion for their covered services.
The claim gets sent to Medicare for their portion. They do not pay for anything other than the chiropractic adjustment, and since I used the appropriate modifiers showing that the patient and I know the other services were not allowed I can collect any deductible or co-pays not covered by the primary for the other services.
If you don't use the right modifiers from the start, you can't collect for Medicare's non covered services.
dekenn:
Actually, you can change the claim when the primary insurance recognizes the consultation codes and the patient has medicare as a secondary.
http://www.cms.gov/ContractorLearningResources/downloads/JA1010.pdf
On page 4, it answers the question on how to deal the medicare as a secondary. (Sorry, I'm not very computer savvy, don't know how to add a "link", so I had to copy and paste the address ;) )
This is just new for 2010 because of Medicare eliminating the consultation codes.
dekenn:
Never mind about the "link" thing.... it did it for me!!! How do you get the smiley faces though?
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