Billing > Billing
Billing Psych visit 90834 to Medicare for denial - confused about GY modifier
Michele:
Debbie,
When the provider is not enrolled in Medicare (because Medicare does not enroll their specialty) I don't believe you are supposed to submit to Medicare. You should be able to bill the secondary directly with no denial because the secondary should recognize the provider as not being able to enroll in Medicare. They should process as if they were primary. If you are submitting to the secondary on paper you could attach a cover sheet stating "Medicare does not enroll LPC therefore there is no Medicare EOB" or something similar.
PMRNC:
Many secondaries will NOT pay as primary. The patient really should be seeing a Medicare provider or they can pay out of pocket but the secondary may not pay without Medicare consideration. Makes sense, why would they assume primary liability on a beneficiary who has access to a provider who can bill Medicare. My dad runs into this now with his physicians that opted out.
On a good note, legislation was introduced last year to allow LPC's to be covered by Medicare.
shanbull:
--- Quote from: PMRNC on March 11, 2014, 10:44:38 AM ---Many secondaries will NOT pay as primary. The patient really should be seeing a Medicare provider or they can pay out of pocket but the secondary may not pay without Medicare consideration. Makes sense, why would they assume primary liability on a beneficiary who has access to a provider who can bill Medicare. My dad runs into this now with his physicians that opted out.
On a good note, legislation was introduced last year to allow LPC's to be covered by Medicare.
--- End quote ---
This is what we have to do, we have some people with dual Medicare/Medicaid policies that say in the eligibility info for Medicaid that FFS services must be submitted to Medicare first, no matter what, and the secondary insurance requires a Medicare denial to process the claim. If we try to bill the secondary without going through Medicare first, we get a denial from the secondary.
rdmoore2003:
--- Quote from: PMRNC on March 11, 2014, 10:44:38 AM ---
On a good note, legislation was introduced last year to allow LPC's to be covered by Medicare.
--- End quote ---
Just waiting for Medicare to actually cover is the frustrating part.
PMRNC:
--- Quote ---Just waiting for Medicare to actually cover is the frustrating part.
--- End quote ---
You have to think of this from another angle .. WHY should any other secondary payor assume primary responsibility/liability when the patient can be seen at a covered provider and reimbursed / considered by Medicare FIRST. Most carriers follow Medicare.
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