Wiki Billing Medicare Pt's w/2nd Ins for a CPE

[GORSKICHRISTINE]

My question is...If a Medicare pt has secondary ins can you bill the secondary the full amount of the physical charge when being billed w/ an ov? And if so...if the secondary pays but the pt has a pt balance can it be billed directly to the pt as along as it doesnt exceed the formulated amount by medicare. If anyone has documentation to support this I would greatly appreciate it.

 

[Candace Rockett]

M-Care and Secondary Ins

First, which insurance is primary? Is it Medicare? If Medicare is primary, you bill them first, and upon reciept of the EOB/RA you bill the secondary for the balance not covered by M-Care, and attach a copy of the EOB. Remember to use the correct fee schedule also, according to PAR, non-PAR or Limiting Fee.

 

[GORSKICHRISTINE]

cpe medicare

Yes Medicare is primary & united is 2nd. I had a "billing teacher" tell me its faudulent. Basically, we billed an ov 99214 Medicare allowable is $109.75, Routine exam $275. The secondary ins (united health) pd us $207.65 and said the coinsurance is $67.35. Which we billed the pt. I know that if the pt did not have a secondary or that the secondary did not pay we could only charge the pt $165.25. (275-109.75). Thanks for your help.