Auto/ Primary/ Secondary billing order

gtaylor

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I have a patient that was clearly injured in an auto accident last October 2011. I just started working here last month. The patient has been seen here since Nov 2011. He has auto insurance that is in litigation. The company has been filing through his primary insurance (which sent a letter of denial) and now filing through Medicaid with the primary letter of denial. They have never billed the auto insurance or have any information in his file on the auto insurance. I printed the HICFA today and it said "No" for auto related. When I questioned them about this, they said that the auto in in litigation and may take years to settle. Once settled, they will pay back Medicaid. My response was, not if there aren't any claims on file.

From my experience, I was taught to file auto, then primary, then secondary. Also, I feel it should be marked "Yes" for auto related.

Which way is correct?

Also, if I'm correct, could this company be in jeopardy for possible fraud for marking "No" and not billing auto?

Please advise. Thank You.
 

JMeggett

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I have a patient that was clearly injured in an auto accident last October 2011. I just started working here last month. The patient has been seen here since Nov 2011. He has auto insurance that is in litigation. The company has been filing through his primary insurance (which sent a letter of denial) and now filing through Medicaid with the primary letter of denial. They have never billed the auto insurance or have any information in his file on the auto insurance. I printed the HICFA today and it said "No" for auto related. When I questioned them about this, they said that the auto in in litigation and may take years to settle. Once settled, they will pay back Medicaid. My response was, not if there aren't any claims on file.

From my experience, I was taught to file auto, then primary, then secondary. Also, I feel it should be marked "Yes" for auto related.

Which way is correct?

Also, if I'm correct, could this company be in jeopardy for possible fraud for marking "No" and not billing auto?

Please advise. Thank You.
Dealing with Auto claims is challenging to say the least. In our Ortho office we have a policy that if the patient has PIP benefits readily available (and we talk to the Claims Adjustor before making that 1st appt) then we'll bill the MVA ins. If there is an auto claim in litigation we will NOT bill the MVA ins because it CAN take years for settlement. The patient has to agree to pay cash up front for each visit and get reimbursed after settlement OR the patient works it out with their medical ins that we can bill them and then they'll get reimbursed after settlement. Sooo...it is possible your employer has a similar policy in place? In litigation settlement there doesn't need to be claims on file with the MVA ins because from what I've seen they cut a check straight to the patient.
Ask again for someone to walk you through their process and explain this is really concerning to you, and hopefully they can ease your fears. There's nothing worse than starting a new job and seeing things that make you wonder whether you've made the right choice!
Jenna
 
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