Patient only has Part A & a Commercial/PPO 2ndary

[thompsonsyl]

Hi,

You are a billing for professional services only, not facility. When a patient only has Medicare Part A, do you bill them for a denial before billing their 2ndary coverage? There is a debate going around in my office about the "right" way to do this. Many have never billed Part A for a denial and others are saying that's the way to do it.

Any thoughts? Can you share what your office does in this scenario, please?

Thanks!

 

[csperoni]

If a patient only has Medicare Part A, for professional services, their commercial is the primary carrier. Therefore, we would not bill Medicare at all.

 

[b.cobuzzi]

Exactly. Part A is for facility services. If they have a commercial PPO policy, it is probably a qualified group health plan, which is the reason one can delay getting Part B. You just bill to the commercial PPO for professional services as csperoni indicated. The patient will probably be responsible for the coinsurance from their commercial PPO.