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.
QuoteI 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. 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.
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.
See, here is the thing, I DON'T authorize benefits for them. This is a fairly easy account really, they send the day sheets and their schedule and I submit claims, post payments, statements in their system. Their OM verifies insurance and when it states medicare in the insurance column it does not state "replacement". I don't even see the insurance cards or anything. So I started looking at the age of the patient to determine the use of the modifier so I know won't have the denials.
QuoteSee, here is the thing, I DON'T authorize benefits for them. This is a fairly easy account really, they send the day sheets and their schedule and I submit claims, post payments, statements in their system. Their OM verifies insurance and when it states medicare in the insurance column it does not state "replacement". I don't even see the insurance cards or anything. So I started looking at the age of the patient to determine the use of the modifier so I know won't have the denials.Do you mind if I ask are you billing them a %? If so it's to your benefit to take over this duty, if it's not or not included in your services your charging for, perhaps you can suggest adding it (at cost of course) and be sure they realize the importance of the task and how essential it is in the reimbursement process. they will be either TOO happy to let you do it OR get busy themselves and make sure they do it, Only one of those two are going to ensure proper reimbursement.