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Medicare as Secondary Payer

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LisaB53:
Hello Everyone,

I am not a professional biller I just try to help my cousin out as best I can.  He is a Chiropractor and is semi retired.  He has mostly cash clients and I bill his medicare clients.  The only insurance company he participates with is Highmark Blue Cross and Blue Shield.

He has a patient that was using Medicare but now has signed on with a PPO.  The PPO insurance company will not pay because he is not a participating provider.  After the denial remittance comes back from the insurance can he then bill Medicare?  I didn't know how something like this might work.  Maybe Medicare figures it's his problem since he doesn't participate with the insurance company.  I wanted to ask about this before he has me send a bill to his patient.

I really don't know how you all do this, I find it so very confusing.

Thanks,
Lisa

DMK:
If the PPO is a Medicare replacement plan it (the PPO) is now the insurance you bill, not Medicare.  Medicare isn't secondary either.  We run into this more and more.  The doctor must be on the plan IF the plan only pays in-network.  There's no way around it. 

Also, if he does participate with the plan make sure you still code it EXACTLY like you would code for Medicare and BE SURE to document the same as Medicare.

LisaB53:
Thank You for the information.  My cousin is pretty old fashion and when I asked him if he wanted me to help him register with the insurance company he said no, he's tired or playing all these games.  I guess he's lucky that he is starting to wind down his practice.

Lisa

DMK:
I completely understand the desire to not play the game!  Unfortunately, it's part of the healthcare business.  It's everchanging and ever will be.

PMRNC:
I've done more de-credentialing in the past year than credentialing.. LOL  BCBS contracts are the worst to get out of. I've also been getting doctors out of Medicare and Medicaid like crazy, I try to tell them they are being pre-mature because I don't see Obamacare getting off the ground at all once the new president gets in there  ;D :o ;)  But many of them said it's just one threat to many for them and they want out of govt sponsored plan's. I've also observed that the other carrier's are making it even easier for doctors to sign up now and that once closed panel's are opening up :)

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