Results 1 to 5 of 5

Billing Question?

  1. #1
    Default Billing Question?
    Medical Coding Books
    I have a patient who has Medicare primary and BS secondary with a $15 copay. Our charge billed to Medicare was $65. Medicare paid $50.95 with a write-off amount of $1.31 which left a balance of $12.74 which we forwarded to BS secondary. BS paid $0 but said the patient had a $15 copay. Can we bill the patient the $12.74 plus the $1.31 which would equal the $15.00 copay or just the $12.74 which is what Medicare said we were allowed to bill the patient?
    Thanks in advance for your help.

  2. #2
    You can only bill the Medicare balance to the patient. It would be fraud to charge them any more.

  3. #3
    Swainsboro/Statesboro, GA
    Default I agree
    I agree with billing only what Medicare states you can bill.

    And I wish our visit charges were in that price range!

    Savannah, GA

  4. #4
    Hello everyone!

    Medicare A/R Biller says:

    Typically, if a patient has Medicare, and the other policy has a COPAY, that generally means that it is a GROUP (not retiree) plan through the patient or spouse's employer.

    If the patient is Medicare eligible (65+) and is still working in a employer plan of 20 or more employees, then the Group Plan (patient OR Spouse) would be prime and Medicare would be 2nd. (Check with Medicare if the patient has ESRD or Disability, as rules are slightly different).

    In other words: If a Medicare patient is presenting with a card that states he/she has a COPAY, good chance someone is still working. To my knowlege the retiree cards (Medicare supplement plans) do not have copays listed on the cards when Medicare is primary.

    It would be wise to call the Medicare IVR at 1-877-908-8431 and the other 1-800 number on the card and confirm eligibility information.

    I agree with everyone above: legally, you can only keep what the Medicare allowed amount is minus Medicare payment = patient coins. and deductible.

    Hope this is helpful!
    Sunni Hearin
    Tacoma, WA

  5. #5
    Jacksonville Beach, FL
    You can only bill what Medicare says the patient owes. We have had to refund patients because the primary allows less than the secondary.

Similar Threads

  1. Billing Question
    By acosta6 in forum Billing/Reimbursement
    Replies: 1
    Last Post: 01-30-2015, 02:20 PM
  2. Billing Question
    By tcoder5 in forum Podiatry
    Replies: 4
    Last Post: 08-26-2013, 06:20 AM
  3. Replies: 1
    Last Post: 11-02-2010, 08:54 PM
  4. billing question
    By paula f3 in forum Anesthesia
    Replies: 3
    Last Post: 10-10-2009, 02:39 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.