Wiki Medicare as Secondary

[Snflwr]

Hi everyone! I have a pt that has commercial ins as primary and Medicare as secondary. Pt has a balance left over after primary pmt that was billed to medicare, medicare did not cover full payment for the remaining balance the primary ins said the pt owes, can we bill the patient for the remainder minus what Medicare paid since it is still owed from the primary pmt. This is the first time I have experienced Medicare as a secondary payor.

 

[tonya_michelle]

How would you get reimbursed for that amount owed after Medicare paid their part? You would have to bill the pt for the remaining balance.

 

[Snflwr]

I said that we should bill the patient but I spoke with a different office and they said they always write it off, of which I thought was incorrect. Thanks, just need re-assurance that I can bill the patient.

 

[Kirstyn20]

The Medicare remit should tell you the amount that you are able to bill the patient. If it says $0, you will need to w/o the difference. Medicare pays less than commercial insurances so if the primary paid more than what Medicare allows, they won't pay.

 

[renee.217]

If Medicare has allowed the charge and paid a partial amount and has not indicated that it is a write-off you can bill the patient.

 

[amym]

You can bill the patient only for the amount indicated on the remittance under co-insurance or deductible. Make sure your primary diagnosis was not phsych related. Medicare deducts for phsych related services.

 

[murphyrrm]

Medicare as a secondary

Since M/Care is a Secondary, Look at you RA and make note of CO-45 (Contractual Obligation W/off) and PR - 2 (Patient Responsibility COINS)..Once Medicare adjudicate the claim they will pay 80% of allowed amount and if PR -2 is listed that amount would be the patients responsibility.