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medicare primary billing

  1. Default medicare primary billing
    Medical Coding Books
    One of our billers sent a claim to our PT's secondary insurance because they didn't have Part B Medicare benefits (we're in a doctors office), but now the secondary is asking for a refund of previous payments because the PT has medicare primary.

    If a patient has medicare primary but has no Part B Medicare benefits should a doctors office bill medicare first anyway, and then the secondary?

  2. #2
    We ran into this once with one of our patients. We ended up submitting claims to Part B just to get a denial, and then sent the claim to the secondary insurance, even though they weren't technically secondary!

    Another time, one of our patients took out a commercial policy that she thought would be her primary insurance, but turned out to be a Medicare supplement plan, and she didn't have Medicare Part B !! The supplement would only pay Medicare deductible and co-insurance. Since there were none of these things, they paid nothing! The patient was paying premiums for this policy that did her no good at all!

    I would investigate further the particular circumstances in this case. It could be that the patient is Medicare eligible, and the insurance just wants verification that the patient doesn't have it. If that's the case, you'll have to get the patient involved to help you get this straight.
    Walker Bachman, CPC, CPPM

  3. Default
    that is silly! You would think a medicare supplement policy would check to see if the patient even had medicare! ...or maybe not ^^

  4. Default
    i see a lot of insurances that will only pay what they would have paid if patient had Medicare part B. They simply state that if patient is eligible age for medicare part B and patient elects not to have medicare part b, that they are still only going to pay whatever balance would have been billed to them if medicare did pay.

    now this is crazy!!!!!!!!!!!!!!!!


  5. Default
    I had a pt who did not have have MCR Part B benefits so her insurance would "carve out" and paid as the supplemental would pay. They only paid the 20% coins. Upon calling them, I was told they "carve out" because the pt has eligibility for MCR Part B benefits and need to apply for the MCR Part B. My pt did not want to apply for the MCR B benefits, she was fine paying out of pocket for the first year. Her son called us one day to see why we were billing her, after a long conversation with the son, his mother did apply for the MCR B benefits.

  6. #6
    Always bill Medicare first, if nothing else, just to get the denial for secondary ins.

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