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Can you balance bill Medicare Secondary payer patients?

  1. #1
    Question Can you balance bill Medicare Secondary payer patients?
    Medical Coding Books
    If Auto insurance is primary and they pay 80% of the entire bill which is, of course more than Medicare allows. Can I bill the 20% to the patient? Thanks.

  2. #2
    North Carolina
    30.2.1 - Provider Bills No-Fault Insurance First

    (Rev. 37, Issued: 10-14-05, Effective: N/A, Implementation: N/A)
    If the services are related to an automobile accident, the provider ascertains whether coverage under no-fault insurance is available. If a provider learns that no-fault insurance may pay for otherwise covered services, it must bill the insurance company as primary insurer during the promptly period. If the no-fault insurance will not pay promptly, the provider may bill Medicare for conditional payment.
    If no-fault insurance does not pay or does not pay in full and there is indication of primary GHP coverage under Chapter 1, §§10.1, 10.2, or 10.3, the provider must bill the GHP for the services not paid in full. It may bill Medicare for secondary benefits only after all primary payers to Medicare have been billed.

  3. #3
    Rebecca, thank you for responding. I have already billed the Auto Ins and they paid 80% of the entire balance. I billed MC as secondary and they did not pay anything because the Auto paid more than MC allows. My questions is: Can I balance bill the patient for the 20% not paid by the Auto Ins?

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