Payments > Insurance Payments
Medicare replacements
QueenAlicia:
I have a new client that is Chiro and has a lot of Medicare replacements. I have limited view of their software as I am using their Practice Mate system. I have to go to the patient visits to look to see of they have secondary insurance to either submit secondary claims. Now, to the question, is there a list of medicare replacements out there to use to help to know when I am billing Medicare or United Healthcare or another insurance ?
I think she expects me to know already and read minds because I see UHC on the insurance and not Medicare when I bill causing the claim to not be paid. She won't let me know what the replacements are.
Any help with figuring out the medicare replacements?
RichardP:
I assume you know that Medicare forwards claim info to many secondary insurance carriers. We do very little secondary billing on our Medicare patients because of this. But the secondary insurance needs to be in the database (for us anyway) for purposes of posting payments received from that secondary.
We get paid a percent of all monies collected. If the doctor doesn't get paid, neither do we. Therefore, our client agreement emphasizes that the client must provide us with all information that we need to get them paid. For new patients, and for established patients who have changed either address or insurance, the client must provide to us copies of the demographic and insurance information. The client's office enters that data into the database. But if it is wrong, we won't get paid. Therefore, we use the info they provide us on new patients to verify that the information in the database is correct. We correct the info ourselves if it is incorrect. Staff turnover amongst our clients is high enough to make doing this cheaper for us than constantly spending our time to train and re-train our clients' staff.
You might gently but firmly insist on a similar set-up with your clients. As you've just demonstrated with your post, if you don't have all the information you need to get your client paid, he won't get paid. The client should understand that logic.
PMRNC:
--- Quote ---I assume you know that Medicare forwards claim info to many secondary insurance carriers. We do very little secondary billing on our Medicare patients because of this. But the secondary insurance needs to be in the database (for us anyway) for purposes of posting payments received from that secondary.
--- End quote ---
Medicare replacement plans are NOT secondaries. Basically it is Medicare Part C, and a patient MUST have Part A and B. If they are "eligible" for A and B, they can have Part C and it's provided via various commercial carriers. When Part C is active, parts A and B are INACTIVE since C will cover BOTH medical and hospital benefits. With Part C the benefit can often be lower out of pocket with options added such as pharmacy, dental, vision etc not normally covered by Medicare A/B. The exception I believe is Hospice Care which is not covered through a Medicare Replacement plan (part c)
Now, not to mince words but it's important, are you speaking of Medicare Secondaries, Replacements (as explained above) or Supplemental. They are all different. With Medicare Replacement plans you will treat that plan like another commercial and verify benefits with that carrier, you may not even know it's a Medicare Replacement unless the ID card says it. I've seen some that say actual "PART C coverage" and I've seen others say "Medicare Replacement". Important regardless to get the ID card and verify benefits as you would all other patients with their carrier.
RichardP:
I did not intend to equate secondaries (or primaries) with Medicare replacement plans. I was just trying to cover all the bases with QueenAlicia. Regardless of what Medicare replacement plans might be (or how she might be defining them), she needs to be able to see a copy of all current insurance cards so she can verify that the info in the dbase is correct - as I laid out above. :)
At any rate, to answer QueenAlicia's question, try this link. The plans available vary by state.
http://www.longtermcarelink.net/eldercare/ref_list_medicare_advantage_standalone_PDP.htm
This link might be of use to somebody, so I'll include it also:
http://www.q1medicare.com/PartD-SearchMA-Medicare-2013PlanFinder.php
QueenAlicia:
--- Quote from: PMRNC on January 02, 2013, 04:31:44 PM ---
--- Quote ---I assume you know that Medicare forwards claim info to many secondary insurance carriers. We do very little secondary billing on our Medicare patients because of this. But the secondary insurance needs to be in the database (for us anyway) for purposes of posting payments received from that secondary.
--- End quote ---
Now, not to mince words but it's important, are you speaking of Medicare Secondaries, Replacements (as explained above) or Supplemental. They are all different. With Medicare Replacement plans you will treat that plan like another commercial and verify benefits with that carrier, you may not even know it's a Medicare Replacement unless the ID card says it. I've seen some that say actual "PART C coverage" and I've seen others say "Medicare Replacement". Important regardless to get the ID card and verify benefits as you would all other patients with their carrier.
--- End quote ---
From what I know if the patient does not let Medicare know that they have a secondary it will not automatically forward to the secondary. I have been seeing this the past few months with one of my providers patients.
Yes, Linda, this is what I meant. For example United Healthcare was the replacement but in the patients demo's it stated Medicare and did not say UHC was the replacement causing it to be submitted without the AT modifier. When I spoke to the provider she had the attitude as if I was supposed to know. I asked " are there a lot of your patients with medicare replacements?" and she says that there are a lot". I was thinking you may want to let me know now what the medicare replacements are so that this does not happen again.
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