HELP Billing Medicare as a Secondary

bmcginnis

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I work for a small physical therapy practice and need help billing Medicare as a secondary. Here's my scenario: I have two patients coming in for the same thing. DX is the same, primary and secondary ins is the same, even their employer is the same. Claims were submitted at the same time. One claim gets paid, the other doesn't. I cannot figure out why.

My claims have been rejected a few times by Medicare for various reasons. The first time, they rejected stating that the primary payor EOB was not submitted with the claim. I know I submitted the EOB. Regardless, I re-submitted and made sure the EOB was attached. It was rejected.

This time it gets rejected because the claim for does not show Medicare as a secondary. I have visited the medicare website and reviewed my claim form box by box and still cannot figure out why these claims are not being paid.

Can someone PLEASE help me figure this out? This is driving me insane.

Billie Jean McGinnis, CPC-A
Monticello, NY
 

msr1984

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2ndary Medicare

Is your practice allowed to submit electronically?? Do you have the Medicare secondary payer reason listed??? Those are usually the most common problems.
 

bmcginnis

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We are not set up to bill electronically yet. I'm hoping to have that set up in the very near future.
 

lmcintyre

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Have you spoken to Medicare? It could as msr1984 says, be something as simple as the 12 or 43 MSP code, but it could also be that Medicares files have been 'updated' and they no longer show a primary carrier. I've had silly things like that happen! Good Luck!!
 
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