• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We’re introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Can you balance bill Medicare Secondary payer patients?

Messages
4
Location
OCALA, FL
Best answers
0
If Auto insurance is primary and they pay 80% of the entire bill which is, of course more than Medicare allows. Can I bill the 20% to the patient? Thanks.
 

RebeccaWoodward*

True Blue
Messages
3,126
Location
North Carolina
Best answers
0
30.2.1 - Provider Bills No-Fault Insurance First

(Rev. 37, Issued: 10-14-05, Effective: N/A, Implementation: N/A)
If the services are related to an automobile accident, the provider ascertains whether coverage under no-fault insurance is available. If a provider learns that no-fault insurance may pay for otherwise covered services, it must bill the insurance company as primary insurer during the promptly period. If the no-fault insurance will not pay promptly, the provider may bill Medicare for conditional payment.
If no-fault insurance does not pay or does not pay in full and there is indication of primary GHP coverage under Chapter 1, §§10.1, 10.2, or 10.3, the provider must bill the GHP for the services not paid in full. It may bill Medicare for secondary benefits only after all primary payers to Medicare have been billed.

http://www1.cms.gov/manuals/downloads/msp105c03.pdf
 
Messages
4
Location
OCALA, FL
Best answers
0
Rebecca, thank you for responding. I have already billed the Auto Ins and they paid 80% of the entire balance. I billed MC as secondary and they did not pay anything because the Auto paid more than MC allows. My questions is: Can I balance bill the patient for the 20% not paid by the Auto Ins?
 
Top