Wiki Medicare part A only for professional services

[tnash65]

Hi, I am trying to get a secondary claim paid whereas the patient has Medicare part A only as primary. My physician saw patient at facility while on call and I haven't been able to find any type of denial code to append to Medicare denial, is there a modifier or code that can be used to indicate part A only? Thanks!

 

[thomas7331]

There's no special coding you need to do for this situation. If the secondary payer has current information from the patient about their Medicare coverage, then they should already know that if the patient only has Part A and that the physician services are not going to be a covered service under that patient's Medicare, and they should process the claim accordingly. In fact, I don't think you would even need to bill the services to Medicare and get a denial - you should be able to just bill the secondary payer as if that was the patient's only insurance. If the insurance is doing their job correctly, they should not need to see a Medicare denial for every claim.

 

[tnash65]

There's no special coding you need to do for this situation. If the secondary payer has current information from the patient about their Medicare coverage, then they should already know that if the patient only has Part A and that the physician services are not going to be a covered service under that patient's Medicare, and they should process the claim accordingly. In fact, I don't think you would even need to bill the services to Medicare and get a denial - you should be able to just bill the secondary payer as if that was the patient's only insurance. If the insurance is doing their job correctly, they should not need to see a Medicare denial for every claim.

I think you are absolutely correct, they aren't doing their job, but thank you for the updated information.