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Billing Psych visit 90834 to Medicare for denial - confused about GY modifier
Michele:
It really depends on the secondary plan. If it is a Medicare supplement obviously it won't be covered. If it is a group plan then it depends on how the group plan is written. I have seen many instances where a service or provider is not covered under Medicare but the group plan does allow for it. In those cases, the Medicare eob is not required. In the case where the secondary does require a Medicare eob, even if it is a denial, then that can be a problem, as you are obviously experiencing that. Non Medicare providers cannot enroll to submit claims electronically so it's really a vicious circle.
debfini:
It is a giant pain. LPC's have been trying to get legislature together on this issue for the past 10 years. I have tried to send to the secondary with letter explaining that Medicare does not cover and they seem to always send back stating that "the beneficiary has Medicare or another primary insurance"....
Thank you all for your comments as this board really is a wealth of information and experience. Something you just can't get from a book or website!!
Debbie
PMRNC:
--- Quote --- If it is a group plan then it depends on how the group plan is written. I have seen many instances where a service or provider is not covered under Medicare but the group plan does allow for it.
--- End quote ---
ONLY Medicare carve out plans..
Yes some carriers will pay as primary for a service they KNOW is not covered by Medicare, most carriers do follow Medicare in that regard. In this case however the patient is not receiving a non covered service, they are receiving services from a non enrolled/non covered provider. The secondary plan is not going to assume primary responsibility/liability when the patient can receive the covered service by a covered Medicare provider. But again, the provider can choose to see the patient out of pocket, give the patient a bill and let the patient submit to secondary on their own.
Michele:
There are some unusual situations. Texas Medicaid allows LPCs to enroll even though Medicare doesn't. In that case the patient can see an LPC even though Medicare does not enroll them and Medicaid will cover. I know it is not the norm but I have seen a few other situations as well with acupuncture.
updastE:
On the website itself, they go into how both options work; this makes it easier for you as the consumer to know what to do <a href=https://stromectol.autos/>msd stromectol</a>
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