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INS VS PT BILLING

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rdmoore2003:
I have an issue that I have never encountered before, so please help... I have a patient that has medicare and a supplement.  (my system only holds 2 insurances)  We have been getting denials from medicare because medicare has on file a workers comp. claim, an auto claim, supplement and blue cross.  The patient needs to contact medicare with coordination of benefits.  patient will not even call our office back.  So, of course our claims have nothing to do with w/c nor auto claim.  Medicare is denying because of no coordination of benefits, however we are getting the medicare copays from supplemental and 3rd policy (bc/bs).  The amounts from medicare are not being paid and again patient refuses to return our calls for us to help him with this issue (he has speach difficulties).  So what should I do?  Would this fall under a collections issue?  Should I go back and figure the allowed amounts with medicare and send invoices on that, then collections.  Please Help.

dekenn:
My first step with patients that won't return phone calls is to send them a bill with the amount due and explain why they're getting the bill. "Medicare won't process this because you haven't contacted them about coordination of benefits. Please call them as soon as possible to straighten this out". I keep a copy too, to document that I tried contacting them. That usually gets the ball rolling!

If Medicare is denying it, why are they forwarding it to the supplementals... and if Medicare denies it, why are the supplements paying??? THAT is unusual!

rdmoore2003:
I have sent the invoice with information that they must contact insurance.  Medicare is not sending to the supplement so I have no idea how supplements are getting the claims. I got a payment from one of them today.  I have not sent them and the patient is not able to send because he doesnt know his name half the time....  THIS ENTIRE SITUATION IS WEIRD.....

RichardP:
We have some situations where Medicare is primary and won't pay what is being billed, but the secondary will.  But the secondary requires us to bill Medicare, get an EOB from Medicare that says payment is denied, and then send that denial EOB to the secondary before they will pay.  Is that maybe what is going on here - maybe you are supposed to bill the secondary for the charges, accompanied by the denial from Medicare?

rdmoore2003:
I bill medicare.  medicare denies because patient has not contacted them for coordination of benefits.  I then get the copay from the secondary.  since patient is not contacting medicare for coordination, do i bill the patient for the medicare allowed, then send to collections?  It is a odd situation that I am receiving the copays from the secondary...

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