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INS VS PT BILLING

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PMRNC:

--- Quote --- We have been getting denials from medicare because medicare has on file a workers comp. claim, an auto claim, supplement and blue cross.
--- End quote ---

You had mentioned other carriers.. it might be a problem of the patient being OVER insured. It happens. It could be that Medicare has to have additional information on the bc not the supplement?   I'm just guessing. 

rdmoore2003:
this entire situation has dumbfounded me.  The patient is over insured but our claims have nothing to do with wc or auto claim.   bottom line is the patient is not contacting medicare to coordinate so really my question is to mark each visit with medicare allowed amount and bill patient that amount?  The claims will not be processed correctly if coordination is not done so pt is responsible, right?   

PMRNC:

--- Quote ---this entire situation has dumbfounded me.  The patient is over insured but our claims have nothing to do with wc or auto claim.   bottom line is the patient is not contacting medicare to coordinate so really my question is to mark each visit with medicare allowed amount and bill patient that amount?  The claims will not be processed correctly if coordination is not done so pt is responsible, right?   
--- End quote ---

I would say so. I certainly would bill them accordingly but include a note that Medicare is awaiting additional information. I've done it with other carriers regarding COB coverage, even if we are par we need to be paid and if carrier is holding up because of info they need from the claimant/insured.. stands to reason we could "bump" it along with reminders. Now whether it's "collectable" becomes another story.

Merry:
From a legal standpoint..and I am not an attorney but familiar with this situation.
It is solely the patient's responsibility to inform Medicare of any changes in their insurance. It is a MEDICARE PROCESS and a patient can be legally held responsible for any charges not reimbursed because the information on file is not current or correct. You need to inform the patient that they need to call Medicare and I would also tell them that if this is not handled within a certain time period, then they will be responsible for the charges that are not paid. The patient is responsible for making sure that their information at Medicare or any other insurance company is correct.

rdmoore2003:
Here is an update on this topic.   The patient contacted his old workers comp carrier trying to demand for them to pay his bill....funny right.  Workers comp told him that he has to do the same thing I have been telling him,  you must contact medicare to do your coordination of benefits.... so after 6 months, he finally did it.   I received a call from medicare verifying that he had updated.  They said I must resubmit the claims electronically of course with the statement "not worker comp or auto accident related.   So, my question is should I put that statement in line 19? 

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