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Medicare secondary payer??

  1. Angry Medicare secondary payer??
    Medical Coding Books
    I am new to coding and I am having issues with getting claims paid when medicare is secondary. They are rejecting everything and NO one in my office seems to know how to fix it. Any ideas of how to get these claims paid??

  2. #2
    Get a copy of the Medicare Secondary claims manual (google it). Then make sure you are filling out all of the lines on your CMS-1500 correctly.

  3. #3
    One thing I learned working for a larger company is that all of our medicare has to be done electronically, even secondary claims. Have you tried calling them to find out specifically why they are denying them?

  4. #4
    A lot of the times, when Medicare is the 2ndary insurance, the primary pays more than the MDCR allowable for the services. That is usually the primary reason for non payment. I know attaching the primary EOB can also an issue, but most primary payors will electronically submit the claim to MDCR for you as coordination of benefits. But I agree with tomtom and Jackie. Make sure you are filing the claims electronically and that you have a clean claim.

  5. Default
    I work in the Medicare Unit if you can provide me with the denial coder I can help you.

    Alma D, CPC

  6. Smile Msp
    Medicare Specialist. Here are a few sinerio's check to make sure you have the patient MSP type listed correctly on the account. MSP types are the reason why the patient as Medicare secondary. Also make sure your calculation are correct, also make sure with your calculation you have your pr-codes like PR-1,2,3. These codes indicate to Medicare if the balance is the patient deductible, copay or copayment. Next make sure you are using CO-45 for the adjustment codes. Make sure in your billing software your Medicare allowables are loaded in your system. I agree with everyone, if there is something I did not know about a Medicare denial after thoroughly reviewing the patient account. I would call Medicare the Reps are very helpful and most of the time they would refer you to there website. If you can get a Rep to guide you through the site you will be in good shape after this. Let me know what the outcome is.

    Good Luck
    Last edited by svanhorn73; 10-09-2009 at 02:25 AM.

  7. Default
    So for the Adjustment is CO-45, and for patient responsibility PR-1,3, but how about the other insurance payment do I need to add a code to it??

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