medicare secondary insurance

perkins05

Expert
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296
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New Orleans
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If patient has united healthcare and medicare as secondary.
Patient comes in for PE 99397 v700 which we billed but medicare does not recognized PE codes how would you billed the secondary insurance for this encounter? Any suggestions are appreciated...:0)
 

ithomas14

Networker
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If the visit was for PE, you billed correctly, but Medicare will not pay whether primary or secondary. Changing the code would be fraud. You don't want to get caught in an audit doing that.

You can only change codes if you bill the primary for consultation. Then Medicare will let you change to an equivalent E/M per documentation. Of course check with your Medicare contractor for their rules.
 

rthames052006

True Blue
Local Chapter Officer
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1,905
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York, Pa
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If patient has united healthcare and medicare as secondary.
Patient comes in for PE 99397 v700 which we billed but medicare does not recognized PE codes how would you billed the secondary insurance for this encounter? Any suggestions are appreciated...:0)
In this case you will just have to bill the patient as physicals are non covered service under Medicare. No way around that, sorry.... as the other poster said, it would be fraudulent to change the code because Medicare doesn't allow it.

You should also have your patients sign an ABN in situations like this, if you know they are in for a physicial and have Medicare.
 
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