Medicare seems to be overpaying on our MSP claims when the primary payer has a per diem contract.
Example: We have a $80 flat rate for a particular payer we are contracted with. That payer applies the full $80 to the first line item on the claim and then has a zero allowable for all other line items. They may pay $45 and then say the patient has a $35 copay on that first line item. We bill Medicare secondary for the $35 copay and Medicare pays on all lines items where the primary payer had a zero allowable so Medicare ends up paying more than the $35 balance.
Any ideas on how we can get Medicare to process these to only pay the remaining patient balance? Medicare states they are paying correct, but from everything I'm finding, they aren't. They are also then applying patient 20% responsibilty amounts to those line items where the patient had no responsibility from the primary.
We are entering the COB info on the electronic claim showing that those other line items are 100% contractual adjustments with no patient responsbility.