kbreeden
Contributor
Can anyone comment on the way to correctly bill Medicare secondary for the new way of consults. Say if the patient has BC primary and Medicare secondary.
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Wiki Medicare secondary consult codes
- Thread starter kbreeden
- Start date
RebeccaWoodward*
True Blue
I can share what my carrier instructed recently.
If the patient has BCBS prim and Medicare 2ndry, bill BCBS as you normally would. example: 99244 (assuming they haven't adopted Medicare's new policy). Once this is paid by BCBS, you change the CPT code to reflect the correct code for Medicare. Our carrier made it very clear that it was appropriate and correct coding to make this change. Now...the hard part is how to report the primary payment. Our carrier will not accept paper claims w/ paper EOB's so the solution was to void the original charge, repost, and report the primary payment electronically. Talk about NUTS!
If the patient has BCBS prim and Medicare 2ndry, bill BCBS as you normally would. example: 99244 (assuming they haven't adopted Medicare's new policy). Once this is paid by BCBS, you change the CPT code to reflect the correct code for Medicare. Our carrier made it very clear that it was appropriate and correct coding to make this change. Now...the hard part is how to report the primary payment. Our carrier will not accept paper claims w/ paper EOB's so the solution was to void the original charge, repost, and report the primary payment electronically. Talk about NUTS!
Lisa Bledsoe
True Blue
Our system does not allow us to make a change after the primary pays because it is automatically sent on to Medicare, so like Liz said, we are just writing it off. How beneficial for Medicare!
RebeccaWoodward*
True Blue
Lisa,
That's the predicament we're in. If we do the void and re-key process, seems to me that we would really be inflating our charges/adjustments since the primary adjustment has already been taken one time. We're still tossing this around...
That's the predicament we're in. If we do the void and re-key process, seems to me that we would really be inflating our charges/adjustments since the primary adjustment has already been taken one time. We're still tossing this around...
kbreeden
Contributor
We thought about that but my physician thinks that this would be considered fraud. I have a MedLearn Matters from Medicare that addresses this and it states to bill the correct code to BC and the take the eob and bill the appropriate E/M code to Medicare. It doesn't specifically say to change the code but to bill the appropriate code. He still feels this would be considered fraud if audited.
RebeccaWoodward*
True Blue
"Bill the primary payer using a consultation code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with an E/M code that is appropriate for the service, to Medicare for determination of whether a payment is due."
Although Medicare's guidance does not instruct you to "change" the code per se, it is implied. I would write your carrier/medical director so that you have it in writing. It's not fraud if Medicare has instructed you/us to file in this manner...
Although Medicare's guidance does not instruct you to "change" the code per se, it is implied. I would write your carrier/medical director so that you have it in writing. It's not fraud if Medicare has instructed you/us to file in this manner...
Lisa Bledsoe
True Blue
Rebecca - that is how we looked at it, plus the time it would take to have someone do the work would likely out-weigh the small portion Medicare would pay. It's a lot of work to get the claim "back" from the primary after they pay, before it goes to Medicare; make the change (depending on the system, it might be very difficult - and confusing), then submit to Medicare electronically with the appropriate information. And it would definately skew statistics/numbers for the clinic and would be a reak nightmare for the CFO when trying to calculate physician paychecks. Not worth it in my opinion.
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This is interesting. We were told to basically pick our poison. If we chose to bill a consult to the commercial carrier we had to take what they paid and write off the balance, we could not change the code and send it on to Medicare as the secondary.
We decided organizationally it wasn't worth the risk with deductibles and other unknowns for commerical carriers and decided to treat the Medicare secondaries the same as the Medicare primaries.
Laura, CPC, CEMC
We decided organizationally it wasn't worth the risk with deductibles and other unknowns for commerical carriers and decided to treat the Medicare secondaries the same as the Medicare primaries.
Laura, CPC, CEMC
RebeccaWoodward*
True Blue
...and this will be exactly why physicians may refuse new Medicare patients. I just saw on the news the other day where one of the Mayo clinics will no longer see Medicare patients....
cheermom68
Expert
consult
What about for a hospital consult? Say BCBS is primary and Medicare is secondary. I doubt that since BCBS is still recognizing consults that they will allow more than one Initial inpatient encounter, so you would have to bill as a consult wouldn't you? I guess you could bill as a subsequent visit but that would be a big loss of revenue.
What about for a hospital consult? Say BCBS is primary and Medicare is secondary. I doubt that since BCBS is still recognizing consults that they will allow more than one Initial inpatient encounter, so you would have to bill as a consult wouldn't you? I guess you could bill as a subsequent visit but that would be a big loss of revenue.
MnTwins29
True Blue
...and this will be exactly why physicians may refuse new Medicare patients. I just saw on the news the other day where one of the Mayo clinics will no longer see Medicare patients....
Wow, that's harsh. Our physician practices are going to not use consultation codes for any patients - here, the reimbursement difference between new patient visits or initial hospital visits and consultation codes is small. Administration determined that it wasn't worth the extra work.
Lisa Bledsoe
True Blue
If you don't use consult codes for non-Medicare primaries, how would they pay? If there is already an admit code submitted by the actual admitting MD they won't be paying another admit code...unless everyone is going to recognize the AI modifier, which I doubt because no one else is not recognizing consult codes. Everything I've read indicates AI is a Medicare only modifier...the no consult code issue is a Medicare only issue.
When it was first proposed to drop consultations, I was all for it because it's so hard to get the docs to follow the rules...but this is truly a mess. Thank you CMS.
When it was first proposed to drop consultations, I was all for it because it's so hard to get the docs to follow the rules...but this is truly a mess. Thank you CMS.
MnTwins29
True Blue
If you don't use consult codes for non-Medicare primaries, how would they pay? If there is already an admit code submitted by the actual admitting MD they won't be paying another admit code...unless everyone is going to recognize the AI modifier, which I doubt because no one else is not recognizing consult codes. Everything I've read indicates AI is a Medicare only modifier...the no consult code issue is a Medicare only issue.
When it was first proposed to drop consultations, I was all for it because it's so hard to get the docs to follow the rules...but this is truly a mess. Thank you CMS.
We are "lucky" in that we don't have many MDs who visit the hospitals for consultations - the vast majorities of consults are done on office visits. There were a few, but again, using the volume of each type of service. Your question on what to do for inpt consultations was not addressed - we are going to see what happens with the first few claims with those to commercial carriers.
MnTwins29
True Blue
If you don't use consult codes for non-Medicare primaries, how would they pay? If there is already an admit code submitted by the actual admitting MD they won't be paying another admit code...unless everyone is going to recognize the AI modifier, which I doubt because no one else is not recognizing consult codes. Everything I've read indicates AI is a Medicare only modifier...the no consult code issue is a Medicare only issue.
When it was first proposed to drop consultations, I was all for it because it's so hard to get the docs to follow the rules...but this is truly a mess. Thank you CMS.
We are "lucky" in that we don't have many MDs who visit the hospitals for consultations - the vast majorities of consults are done on office visits. There were a few, but again, using the volume of each type of service, the decision was made to not use these codes. Your question on what to do for inpt consultations was not addressed - we are going to see what happens with the first few claims with those to commercial carriers.