Starting a Medical Billing Business > Starting Your Own Medical Billing Business

Medicare Primary question

<< < (2/2)

PMRNC:
I've had so many opportunities to bill for LMT's out here but I always refer them out because of that.

Michele:
We used to bill WC and NF for several here in NY.  We actually gave them up because they didn't understand that it took time to get the money.  They want to be paid when they give the therapy and that isn't possible. 

williamportor:

--- Quote from: Michele on March 19, 2018, 09:56:25 AM ---Since Medicare does not credential LMTs you cannot submit the claim to Medicare.  They won't process it.  So there is no way to get an EOB from Medicare.   So you are right, you can't submit it to Medicare to get an EOB.  And you can't submit to the secondary stating you submitted to Medicare. 

However, IF the secondary does allow LMTs to submit claims you can contact them to ask them if they will cover it in this situation with Medicare prime.  The reason I say this is because we bill for an Acupuncturist.  Medicare does not credential them either.  We do have patients with secondary plans that allow acupuncture and the claims are billed with the GY modifier and they pay.  The claims are not submitted to Medicare since the secondary insurance carrier (UHC - Empire Plan) knows that Medicare doesn't cover acupuncture and doesn't credential acupuncturists.  But Linda is right, you have to be careful.  You cannot do anything to 'trick' the secondary into paying.  Prior to seeing the patient a call should be made to see if the secondary will allow and how they handle it.

--- End quote ---



Thank You folks...good idea on calling the secondary insurance. I'll tell the provider, he's only vaguely aware how to do this, so I'm sure it will be news to him too.  :)

Navigation

[0] Message Index

[*] Previous page