Wiki Compliance with Billing Secondaries

[davisph]

I have a question. We get paid on 92015 if we bill Medicaid as primary instead of secondary when it is truly a seconday on the patient. If the claim crosses over from Medicare code 92015 will deny from Medicaid, but if it is billed directly then it will pay. We do not bill it with a GY modifier because the practice we bill for does not get the ABN's on the pateints. Any suggestions or liability???

Thanks
davisph

 

[MarcusM]

Medicaid is always the payer of last resort and if you are getting payments from Medicaid as primary when they are actually not primary, then at some point, expect them to recoup funds from you for these over payments...and their recoupment process is usually really ugly to reconcile. Usually, the Medicare payment is more than what Medicaid allows so that is why Medicaid does not pay anything on the crossover from Medicare. Check your fee schedules from each.