Wiki Billing Medicare secondary

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JesseL

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Patients primary, GHI allows 80, paid 60, copay 20.

I submitted the claim to Medicare and the deductible was $124.05 with $64.05 as patient responsibility after deducting the $60 paid by GHI.

Does this mean we have to follow medicare's E.O.B. and bill patient for the $64.05 even though we're in-network with GHI?

Does this overrides our contract with GHI and we must follow what Medicare determines as patient responsibility?
 
I'd just charge the $20. I'm not that familiar with secondary payments by Medicare but it seems its just to give the patient deductible credit so that when they do meet the Medicare deductible that Medicare will start picking up the balance after primary.
 
JesseL said:
So we Ignore what Medicare deems as patient responsibility?
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Yes. The patient cant be responsible for more than what they owed under the primary. The fact the patient has secondary isn't to penalize the patient and benefit the provider.

The only time it benefits the provider is if the primary payer has a higher allowed amount than the secondary. However in that case the secondary will typically consider the primarys payment as payment in full if the paid amount is higher that it would it would owed in the absence of the primary coverage
 
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I'm confused why medicare processed the claim this way though.. We're also contracted with Medicare so both contracts are conflicting.. When I called medicare about the claim, the guy said patient is responsible even though we have a contract with the primary, so i dont know what to do.. Federal contracts doesnt take priority over private payor contracts?
 
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