Billing > Billing

Primary or Secondary when 2 insurances

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PMRNC:
I would say about 80% of the time you only need to call the carrier as they have already established primary..especially if it's Medicare..so the first thing I do if it's in question is to contact the carrier.  If the carrier does not have primary on file then I go to the COB rules :)

Pay_My_Claims:

--- Quote from: Michele on August 19, 2010, 11:28:32 PM --- but as a billing service we can't possible call on every patient.  We rely on the provider's office to indicate prime or secondary.  They are not always right, but in most cases they are.

Michele


--- End quote ---

So you don't provide verification as a service??? And when it comes to COB"s and Medicare I ALWAYS double check. I'm held responsible for filing correctly. I DTA!! I guess i'm anal, but I worked at a major hospital and was the Medicare COB officer there. We didnt play with that. We just had a recoupment from Cigna for 28,000 because they paid in full, and now Medicare is primary. since cigna only pays the 20% we took a loss on the claim.

Michele:
No we don't.  We have never had any major problems in 16 years.  Lucky I guess.  We really don't get many patients that it's not very clear who is prime.  If we can't tell, we will call to verify.  Otherwise, we bill it as it is indicated.  I'm a perfectionist, but not anal.  I'll say a prayer for ya though!  JK   ;)

Pay_My_Claims:
LOL, i know the issues of COB and you have been lucky I guess. One of the biggest problems that I have seen in medical offices is verification of insurance. The office I worked at that was the first change I made. They only looked and loaded info from the cards. If a client had Medicare & a private insurance they ALWAYS put Medicare primary. Now with the increase in Medicare replacement plans, I double check medicare coverage. The Optometrist that I bill for has a 9% denial rate due just to COB issues with sending claims to Medicare when the client actually has a replacement plan. Its one of my marketing tools!!

Michele:
Ahh, yes the replacement plans have caused some issues.  We ask our offices to ask all Medicare patients if they've 'signed up for anything new lately' and also 'have you been given any other medical cards?'.  This helps.  They provide us with all cards, then we can determine from there.

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