Wiki Billing secondary insurance when primary pays in full?

[cdneal1105@yahoo.com]

I have worked in billing and coding for many years and have never came across this issue. I recently took a new job and they bill the secondary insurance companies when the primary has paid and in full and there is zero balance left to bill so you are billing a zero balance claim. Is this correct? Can anyone direct me to some regulations on this issue? Just need so feed back, Thanks

 

[LKaf7]

I work for a FQHC and have a contracted rate with Medicaid that must be met. So if the pt has a Medicaid HMO like Caresource, and they do not pay the rate we qualify for, we send a 0 balance to straight Medicaid to get the remainder of the rate owed to us.

 

[thomas7331]

I've also heard of cases with commercial plans where the payments by the primary insurance may be counted toward the patient's deductible on the secondary plan, so even if the primary paid in full, submitting the claim to the secondary insurance can help the patients meet their deductibles.

I don't think there is any legal issue with submitting zero balance claims, but would just caution that someone needs to keep an eye on this and make sure that in the event the secondary pays and creates a credit balance, that this be resolved and the appropriate party refunded in a timely manner. The potential failure to address an overpayment would be the main compliance risk that I can see in doing this.

 

[JAMETH345]

Do you have any examples of secondary insurances that will apply primary insurance payments to their deductible?
Thank you.

John Methgen. BS, CPC-A,CPB