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PLAIDMAN

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I really need some guidance....I realize nailcare and callus debridement are included with each other for Medicare....however....we have many Medicare patients who have a secondary commercial ins. So I bill both 11721 & 11056 to Medicare hoping the secondary payor will cover the charges. If the secondary denys coverage....can I bill the patient for something that should have never "really" been submitted to Medicare?

Both payors denied and put charges as patient responsibility. It does not seem accurate that I send my patient a big fat bill when both charges should not have been submitted together normally for Medicare.

Should I bother billing both ever?

I am really not confident in this process.
 
There is a modifier to append which indicates you are submitting a known non-covered service simply for the denial so it can go to secondary insurance-are you using it?
 
yes we do use the modifier...my issue is the 2ndary is also denying it as patient responsibility...instead of denying for bundling, I could write off a bundling, I cannot write of the patient respons. They actually both denied as patient responsibility.

We dont even put a 59 on the claim to "try" and un bundle...doesnt that seem weird? according to ncci they ARE bundled. This happens everytime I bill these two together.

When I bill major surgery and they deny for bundling they dont put that to the patient responsibility.
 
PLAIDMAN said:
yes we do use the modifier...my issue is the 2ndary is also denying it as patient responsibility...instead of denying for bundling, I could write off a bundling, I cannot write of the patient respons. They actually both denied as patient responsibility.

We dont even put a 59 on the claim to "try" and un bundle...doesnt that seem weird? according to ncci they ARE bundled. This happens everytime I bill these two together.

When I bill major surgery and they deny for bundling they dont put that to the patient responsibility.
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We always bill them as "unbundled" using the 59 modifier and the appropriate Q code and we don't have issues with Medicare because of it. But if we leave off either it is almost always denied.
 
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