Practice Management Alert

Automatic claim crossover from Medicare to secondary insurers should be painless and produce fast payment. It rarely works, however, because Medicaid has unique coding and claim payment rules that are different from Medicare. To make sure that Hollingshead Eye Center in Boise, Idaho, a two-physician ophthalmology practice that includes an ambulatory surgery center, collects all of its payment, office manager Chris Felthauser has a comprehensive, step-by-step program that ensures fast submission of secondary claims and tracks follow-up on filed claims to verify that nothing is misplaced or lost.

Simple Steps Aid Tracking
 
 
When a Medicare payment is received, the billing staff posts the payment and photocopies the Medicare explanation of benefits (EOB). The EOB copies are placed in an accordion file by patient name so when the biller prints the HCFA 1500 Health Insurance Claim form to submit to the secondary insurer at the end of the day, the EOB copy that must be attached to the claim is at hand.
 
The time saver for us is photocopying the Medicare EOB when posting the payment, he says. You have to attach a copy of the EOB to the secondary claim, so copying it when its at hand saves time tracking it down later.
 
Most of my claims automatically crossover from Medicare to the secondary due to our billing system. But, sometimes Medicare has the wrong information regarding the patients secondary. My computer system identifies the secondary. This was a big feature when we looked for our system. Now, when we post from our Medicare EOBs, we know if theres a problem with secondary identification, and we file the claim manually, he says.

Examine Aging Report Every 30 Days

 
Felthauser also runs the practices aging-accounts reports every 30 days, which he says is the best way to keep track of secondary claims that dont get paid.
 
If a crossover hasnt been paid in 30 days, we mail a hard-copy claim. Usually, our manually filed claims are paid within 30 days. If they arent, well be able to tell on the next A/R report we run, and we call to follow up and find out why, he says. With this system, Felthauser says he has no aging accounts over 60 days.

 
Another approach to collecting on Medicare secondaries is to use the patients clout. At Esse Health, a multispecialty group of about 70 physicians in St. Louis, the practice bills secondary insurers only once, and then assigns the claim to patient responsibility if the insurer has not paid in 60 days.
 
The policy is communicated to patients in a variety of ways, says Gwendolyn Ousley, collection manager at Esse Health. We state our policy on our patient financial forms that are signed by the patient at each visit. We also include it in our billing brochure that we give to new patients, on signs at the front desk, and in messages on our patient statements.
 
If a claim filed with a secondary insurer is not paid in 60 days, the practices computer system puts a notice into a tickler file. The billers work from the tickler file and transfer the balance to patient responsibility, using an internal code that indicates there was no response from the secondary carrier. The patient receives a statement that includes a message stating that the primary insurer has paid but the secondary has not, and the account has a balance due that is the patients responsibility. As long as you have given the patient a fair disclosure, such as previously outlined, you can set the standard for patient responsibility any way you like, Ousley says.

 
The following are samples of notification language for patient responsibility policies, suggested by Ousley. Practices can use the language to develop policies and procedures involving secondary-insurance claims:
 
Initial filing for secondary insurer: As a courtesy to you, [Name of Practice] will file your secondary insurance. This is done after payment is received from your primary insurance. [Name of Practice]s policy is to file the secondary insurance once. If there has been no response from your carrier in 60 days, the balance becomes due immediately and payable by you.
 
Copayment responsibility: If your insurance policy requires a copayment, this will be required at the time of service. [Name of Practice] will not file your copayment to a secondary insurer unless you have Medicare as a secondary insurer. However, [Name of Practice] will provide you with any documentation your insurance carrier may require at your request.

 
Once the patient receives a statement that a balance is due, most patients contact their secondary insurer, Ousley says. The secondary usually says it did not receive the claim, prompting the patients to contact our practice. We then give the patient proof of filing. We print a copy of the EOB statement from Medicare and a copy of the HCFA 1500 claim form, and we send it to the patient. We explain that they either need to pay the bill or contact their insurance company to expedite payment, but they are still responsible, she relates. They usually contact the insurer and say, Ive got proof from my doctor that they filed the claim. They are often instructed to fax or mail the claim with proof to the carrier. Once the patient gets involved, we typically get the payment from the insurer, and everybody is happy.

 
Ousley adds that there are patients who refuse to take responsibility. We will send the claim in again to the secondary insurer. We also send the claim and the EOB back to the patient with a letter stating we are resubmitting the claim as a courtesy, and this is the last and final time it will be sent to the insurance company, she says. The letter also states that if there is no response to the refiled claim in 30 to 45 days, the patient is responsible for the balance. If the patient still refuses to pay, consider turning the account over to a collection agency.
 
Note: For more on hiring a collection agency, see page 12 of the September 2001 issue of Medical Office Billing and Collections Alert.
 
Felthauser says, however, that such a strict policy on secondary-insurance filing would drive patients away from his practice. Weve found that when we tried to have the patient do some of the leg work on the secondary, nothing happens, he says. The patients just keep calling or sending notes to us saying we should bill their secondary insurer, and then they complain to the doctors. By us working with the secondaries, we found that patients appreciate the service.
 
The only secondary accounts that are turned over to patient responsibility at Felthausers practice are the ones in which the insurer has a policy of paying only the patient. We have a lot of secondary insurers that wont pay the providers, and instead pay the patients. In those cases, we have flagged those accounts in our computer system, he says. We tell those patients at the time of service that we will file their secondary claim for them, and transfer the amount due to the patients responsibility. We give those patients 30 days to pay, figuring thats enough time for them to receive payment from the insurance company. Its hard to collect up front on those, and we pride ourselves on our customer service, so we wait until the patient gets the check.