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Thread: Medicare secondary consult codes

  1. #1
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    Default Medicare secondary consult codes

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    Can anyone comment on the way to correctly bill Medicare secondary for the new way of consults. Say if the patient has BC primary and Medicare secondary.

  2. #2
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    I can share what my carrier instructed recently.

    If the patient has BCBS prim and Medicare 2ndry, bill BCBS as you normally would. example: 99244 (assuming they haven't adopted Medicare's new policy). Once this is paid by BCBS, you change the CPT code to reflect the correct code for Medicare. Our carrier made it very clear that it was appropriate and correct coding to make this change. Now...the hard part is how to report the primary payment. Our carrier will not accept paper claims w/ paper EOB's so the solution was to void the original charge, repost, and report the primary payment electronically. Talk about NUTS!

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    our clinic is writing off the balance(what Medicare would pay as secondary).

  4. #4
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    Quote Originally Posted by rebeccawoodward View Post
    I can share what my carrier instructed recently.

    If the patient has BCBS prim and Medicare 2ndry, bill BCBS as you normally would. example: 99244 (assuming they haven't adopted Medicare's new policy). Once this is paid by BCBS, you change the CPT code to reflect the correct code for Medicare. Our carrier made it very clear that it was appropriate and correct coding to make this change. Now...the hard part is how to report the primary payment. Our carrier will not accept paper claims w/ paper EOB's so the solution was to void the original charge, repost, and report the primary payment electronically. Talk about NUTS!
    Our system does not allow us to make a change after the primary pays because it is automatically sent on to Medicare, so like Liz said, we are just writing it off. How beneficial for Medicare!
    Lisa Bledsoe, CPC, CPMA

  5. #5
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    Lisa,

    That's the predicament we're in. If we do the void and re-key process, seems to me that we would really be inflating our charges/adjustments since the primary adjustment has already been taken one time. We're still tossing this around...

  6. #6
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    We thought about that but my physician thinks that this would be considered fraud. I have a MedLearn Matters from Medicare that addresses this and it states to bill the correct code to BC and the take the eob and bill the appropriate E/M code to Medicare. It doesn't specifically say to change the code but to bill the appropriate code. He still feels this would be considered fraud if audited.




    Quote Originally Posted by rebeccawoodward View Post
    I can share what my carrier instructed recently.

    If the patient has BCBS prim and Medicare 2ndry, bill BCBS as you normally would. example: 99244 (assuming they haven't adopted Medicare's new policy). Once this is paid by BCBS, you change the CPT code to reflect the correct code for Medicare. Our carrier made it very clear that it was appropriate and correct coding to make this change. Now...the hard part is how to report the primary payment. Our carrier will not accept paper claims w/ paper EOB's so the solution was to void the original charge, repost, and report the primary payment electronically. Talk about NUTS!

  7. #7
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    "Bill the primary payer using a consultation code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with an E/M code that is appropriate for the service, to Medicare for determination of whether a payment is due."

    Although Medicare's guidance does not instruct you to "change" the code per se, it is implied. I would write your carrier/medical director so that you have it in writing. It's not fraud if Medicare has instructed you/us to file in this manner...

  8. #8
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    Quote Originally Posted by rebeccawoodward View Post
    Lisa,

    That's the predicament we're in. If we do the void and re-key process, seems to me that we would really be inflating our charges/adjustments since the primary adjustment has already been taken one time. We're still tossing this around...
    Rebecca - that is how we looked at it, plus the time it would take to have someone do the work would likely out-weigh the small portion Medicare would pay. It's a lot of work to get the claim "back" from the primary after they pay, before it goes to Medicare; make the change (depending on the system, it might be very difficult - and confusing), then submit to Medicare electronically with the appropriate information. And it would definately skew statistics/numbers for the clinic and would be a reak nightmare for the CFO when trying to calculate physician paychecks. Not worth it in my opinion.
    Last edited by Lisa Bledsoe; 01-07-2010 at 01:53 PM.
    Lisa Bledsoe, CPC, CPMA

  9. #9
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    This is interesting. We were told to basically pick our poison. If we chose to bill a consult to the commercial carrier we had to take what they paid and write off the balance, we could not change the code and send it on to Medicare as the secondary.

    We decided organizationally it wasn't worth the risk with deductibles and other unknowns for commerical carriers and decided to treat the Medicare secondaries the same as the Medicare primaries.

    Laura, CPC, CEMC

  10. #10
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    ...and this will be exactly why physicians may refuse new Medicare patients. I just saw on the news the other day where one of the Mayo clinics will no longer see Medicare patients....

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