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Billing two ways for same patient?

  1. Default Billing two ways for same patient?
    Medical Coding Books
    Pt has BCBS primary, Medicare 2ndry.
    I am being asked why we cant bill 99255 to BCBS and when pymt comes in change it on the HCFA form to 99223 to send it to Mcare for the 2ndry payment?
    Or the other scenario Mcare prime bill 99223 and then send it to BCBS for secondary pymt after changing it to 99255.
    This just doesnt seem right. Any info?

  2. #2
    Default
    You have to bill the same for both carriers. You cannot change the codes for each carrier. If BC is primary they need to be billed first. Otherwise this is fraud.

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    Not so quick...

    Medicare will also no longer recognize the consultation codes for purposes of determining Medicare secondary payments (MSP). In MSP cases, physicians and others must bill an appropriate E/M code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes, physicians and others billing for these services may either:

    -Bill the primary payer an E/M code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with the same E/M code, to Medicare for determination of whether a payment is due;

    or

    -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.

    Note: The first option may be easier from a billing and claims processing perspective.

    http://www.cms.hhs.gov/MLNMattersArt...ads/MM6740.pdf

  4. Default
    Thank you very much for the link.

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    Anytime

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