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Thread: Medicare and No Fault Claim

  1. #1

    Question Medicare and No Fault Claim

    AAPC: Back to School
    Patient was in a restaurant and a car came thru the building and knocked him to the floor and was hit by flying furniture. This happened on 11-25-06. The case has now been closed.
    Pt was here yesterday and questioned his balance. He said his neuro doctor release him in October or December.

    His visit diagnoses state Cervicalga for all 4 visits 11-26-07, 12-19-07, 1-31-08, & 2-28-08. He states that these 4 should go through his regular insurance, Medicare and Highmark. I see where Medicare denied them due to NF. Does he need to do something? I don't think that Medicare will pay do due the accident being caused by a car, besides this case has been closed. What is the timeframe when this is not considered NF anymore? Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  2. #2


    Does anyone have an opinion on this matter, please? Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  3. #3


    My opinion is it should have never been billed to Medicare to begin with. You would treat this the same as an MVA.

  4. #4


    Thanks. The main problem with this was that the patient is really unsure of when he was released from his doctor. He said it was October or December. I can see the claims from that date range being denied from Medicare because he was still under the care for the accident at that time. We will send this to the MVA insurance and see what happens.

    Any other opinions?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  5. #5


    Since they have closed his case, he is now liable...Medicare will not process since it was No Fault...you could try to bill Medicare secondary as Conditional, they may process and they will go after the patient or the no fault or deny as being billed secondary conditional, (that is how it should have been billed when no fault denied) then you will have to bill the patient, and he will have to pay and get reimbursement back from his insurance company.

    Lisa W

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