Wiki Billing Primary when Secondary is Medicare

[coop22]

If you bill the consult code if you have commercial insurance as your primary and your secondary is medicare. Is it illegal?

Example Pt has
BC/BS and we send out claim Hospital consult inpatient. And Medicare is secondary.

Are we Still supposed to follow medicare guidelines.
We bill 99222 Consult crosswalk to visit. (We are losing money)

When we could keep it and bill it as primary 99254. Since his primary is BC/BS as per medicare.

 

[LeslieJ]

Does BCBS accept the consultation E/M codes?

It's not "illegal" to submit a code to Medicare unless it's not what was done (fraud).

If Medicare is secondary, it's unlikely that they'll pay on 99254 (if BCBS does pay for that - some payers don't!); then again, it's also likely that BCBS would pay more than Medicare would anyhow so it may be moot.

Might be better/easier if you contacted your Medicare rep with this kind of question - they can advise you better & show you where it says in writing.

Leslie Johnson, CPC

 

[coop22]

Yes BC/BS say Pays 100$ on the E&M for the Primanry ins. 99254 and since their secondary ins is Medicare and Medicare does not reconize that code. It will deny. So it kicks back and asks for the correct code.

So if we were to now send it WITH the ammount that the primay insurance has already paid and with a correct code 99222 and they pick up left over contracted amount if any is left over of their %.