Billing Denied AWV to secondary commerical insurance?

[khristinelouise]

If a patient's annual wellness visit (G0439) is denied by Medicare because the patient has come in too soon and Medicare puts it to patient responsibility, should you bill it to their commercial secondary given that this is a code that only Medicare uses and covers? This is what they are doing where I work but then the secondary denies it as a non-covered charge (of course) and tells us to write it off even though MC put it to patient responsibility. I could really use some insight with this.

 

[haraml7]

What is the denial reason or the remark codes, does it say that that CO-96 and then are there other reason listed next that denial reason. See what other remark codes are used as non-covered, because it could be several reasons why its not covered. Does it say the CPT code is not recognized or its not covered because the patient has already been seen within the time frame. Thanks

 

[taysin93]

That's why we need check Eligibility every visit. if the front desk missed, the biller should have caught it. you can not bill secondary, if secondary paid, it will eventually get the money back. in your case, just bill 99213 or 99214. you just missed a reimbursement for Physical Exam for Medicare.

 

[b.cobuzzi]

I would not bill it to the patient since the practice dropped the ball and did not keep track of the date in which they could bill the next subsequent AWV for the patient. It was not the patient's fault that the annual limit was not met.

 

[hperry10]

I agree with Barbara. When this happened at my previous practice we wrote the charge off. We did not bill these visits as 99213 or 99214 as that is not the service the patient received. The patient was expecting a visit that was covered 100%, whether they have secondary coverage or not. As previously stated, this is the fault of the clinic not the patient.