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Primary Care Coding Alert

Reader Question:

Dig into Specifics Before Reimbursing Tertiary Insurer

Published on Mon Jul 02, 2012

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.
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