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Medicare as second/consults?

  1. #1
    Default Medicare as second/consults?
    Exam Training Packages
    Does anyone out there know how we are supposed to bill consults(inpt) for Medicare when pt has another insurance as primary?
    CRC CPC

  2. #2
    Default
    If im not mistaken you follow the primary insurance guidelines. If they are still paying consults then you bill consults. http://www.lamedicare.com/provider/v...articleid=8237

    Q. Will Medicare contractors accept the CPT consultation codes when Medicare is the secondary payer?

    A. Medicare will also no longer recognize the CPT consultation codes for purposes of determining Medicare secondary payments (MSP). In MSP cases, providers must bill an appropriate E/M code for the E/M services previously reported and paid using the CPT consultation codes. If the primary payer for the service continues to recognize CPT consultation codes for payment, providers 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 CPT 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.

  3. #3
    Default Thank you very much
    Many thanks
    CRC CPC

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    If you can stand the hassle, it's recommended to submit the consultation code to the accepting primary carrier, report the payment to MCR once received, along with an appropriate code for Medicare that best represents the services rendered. This means you would have to change the code for Medicare purposes. I have personally asked this question to our carrier and it's perfectly acceptable.

    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.

    We note that the first option may be easier from a billing and claims processing perspective.

    Page 6:

    http://www.cms.hhs.gov/MLNMattersArt...ads/MM6740.pdf
    Last edited by RebeccaWoodward*; 03-03-2010 at 03:32 PM.

  5. #5
    Default recoding?
    Is anyone out there re-coding these consults to bill to MCR 2ndary? I just found out that our clearing house wont even send the claim through to get a denial. I contacted our software vendor to see if there was a way to re-code and they werent even aware that MCR stopped paying them and said I was the first person to even ask this question.
    Mary Beth Gord, CPC

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    We are just re-coding consults before they go to the primary so that secondary submission isn't a PITA.
    Lisa Bledsoe, CPC, CPMA

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