Wiki Primary vs secondary

[eksebright]

I have a claim where the primary ins is united healthcare and the secondary is Medicare. This PT had a colonoscopy and united paid but dropped the majority to the deductible. When we billed Medicare the denied it for an LCD code and nothing is documented in the chart for us to use. Now Medicare would say we need to write-off the bill but UHC is saying the PT still has a deductible responsibility. Is it alright to bill the PT deductible to the PT or do we need to Write-off the remaining balance?

 

[Walker22]

If you are in-network with Medicare, you are required by contract to follow their LCD's. If you don't, and get a denial, you are contractually obligated to write it off. I don't see anyway around that, unless I am missing something.