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Thread: Billing Question?

  1. #1
    Join Date
    Apr 2007
    Allentown, PA

    Default Billing Question?

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    Portland, Maine


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

  3. #3
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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.

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