Billing > Billing

Billing secondary payer after Medicare

(1/2) > >>

wforal:
Since a supervising physician is not required when billing an NP claim to Medicare, how do I bill the secondary payer if they don't contract with NP's?

Merry:
IS the secondary a supplemental or a Medigap plan? I imagine you are talking about a supplemental since it would not be a problem with Medigap policy as long as Medicare has paid the claim.

I'll leave this one for Linda. She has that expertise. I am the Medicare person.

PMRNC:

--- Quote ---Since a supervising physician is not required when billing an NP claim to Medicare, how do I bill the secondary payer if they don't contract with NP's?
--- End quote ---

That's actually a good darn question..  I'm assuming with the secondary the supervising physician is contracted? I'd say your best bet is to call the secondary and ask them. Since many of the supplemental plans  follows Medicare when denied.. you would think it would be the other way around if they paid  :P ;D  I'd call to find out and if you could post it here so we can learn.

RichardP:
If a supervising physician is not required when billing an NP claim to Medicare, that means the NP has been authorized to bill on his own (otherwise the supervising physician would be the billing entity).  The NP is considered the billing entity, who is qualified to apply to be a participating provider with insurance carriers.

I'm curious if an NP in this situation has the same rights and responsibilities as physicians have in terms of how they are allowed to bill the patient.  That is, our clients who are non-par charge whatever they want to and the patient is obligated to pay.  The insurance carrier cannot run interference for the patient, because the carrier has no contractual relationship with the physician.  I'm curious whether this dynamic extends to NPs - since the issue has come up.

PMRNC:

--- Quote ---I'm curious if an NP in this situation has the same rights and responsibilities as physicians have in terms of how they are allowed to bill the patient.  That is, our clients who are non-par charge whatever they want to and the patient is obligated to pay.  The insurance carrier cannot run interference for the patient, because the carrier has no contractual relationship with the physician.  I'm curious whether this dynamic extends to NPs - since the issue has come up.
--- End quote ---

Wfoal... congrats you have stumped us all. LOL   I think two elements that has to be known  first before guessing,  is if the provider is par with the secondary, and if that secondary is a supplemental or Medigap policy, if it's a supplemental plan then I would really call the secondary instead of trying to guess because this is an excellent question!! The secondary may not credential the NP or even cover them w/out supervision and supplemental's do not have to pay just because Medicare did like Medigap plans.

Navigation

[0] Message Index

[#] Next page