Wiki Overpayment

[coder1]

I need help with this situation. I billed HMO as primary and MCR as secondary according to the patients benefits. The problem I have is MCR and HMO paid as primary. Should I refund MCR the full amount paid? I'm sure the HMO is primary and was confused as to why the secondary MCR paid as primary.

Thanks

 

[lisigirl]

Yes, if the HMO is primary, I would refund Medicare in full. Then you can resubmit a new claim to Medicare with the HMO's EOB.

Although, if Medicare paid in full, they must not know about the HMO. The patient may need to contact them.

Lisi, CPC
eharkler@nmh.org

 

[tpontillo]

I would verify both insurance's to see if they know about eachother first. If they dont then the patient needs to contact the insurance and set up which one is primary and which is secondary

 

[zaidaaquino]

What we do is that we first contact the patient. We let them know that they need to contact both insurances to do a Coordination of Benefits review. We also let them know that, not only has one of the insurances overpaid, but that any future claims will continue to process incorrectly. Once the patient does that, we usually don't need to contact the insurance...the one that should have paid as secondary will take back their overpayment.

Zaida V Aquino CPC
Billing Specialist