Internal Medicine Coding Alert

Question: One of our patients has Medicare as her primary insurance and Gerber Life as secondary. We received a payment from another payer who must be tertiary. Do we owe the refund to the patient or the tertiary payer?

Rhode Island Subscriber

Answer: The correct way to handle the situation depends on the circumstances.

• If there is no balance due and the patient did not pay anything to your group, then you reimburse the tertiary insurance.
• If the patient paid you anything for the service, you reimburse her what she paid and anything left over (if any) goes to the tertiary insurance.