Billing > Facility Billing

Medicare Billing question



I am billing for a HH facility that is not contracted with Medicare. We have a TON of claims for a patient with no payment dating all the back to 2016. The patient has Medicare and BCBS.

When we submit the claims to BCBS they send them back stating that Medicare needs to view first. However, since we are not contracted with Medicare they do not even look at our claims nor do they send an EOP so that BCBS can view them. Is there a way around this? Have you ever been in a situation like this? How can I get them to at least look into the claims?


It depends on what type of policy the BCBS one is.  If it's supplemental to Medicare then they won't consider them.  Honestly I thought that if a HHA is not a Medicare provider they are not supposed to treat Medicare patients so I'm not sure if you can get BCBS to cover it.  Did you call prior to treating the patient?

My understanding is that if the patient chooses to use a non Medicare HHA then they become a self pay.

Hello Michelle!

Thanks for your response. I spoke to BCBS today and they mentioned that I would need to get a Medicare Exclusion letter...
Do you know what this is and how to obtain one? Is this something that we would write ourselves or does it need to come from Medicare?


I do not know of anything specifically labeled as a "Medicare Exclusion Letter".  From what you are describing it sounds like they want something from Medicare stating that you are not a provider.  I'm not sure if you can obtain that since you cannot bill Medicare to get a denial.  You could try to contact the Medicare carrier for your area and ask them if there is anything you can do. 


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