Results 1 to 4 of 4

Medicare Primary and Othr Ins Secondary

  1. Default Medicare Primary and Othr Ins Secondary
    Exam Training Packages
    I just had a question for everyone. Is there a regulation set by medicare that says when they are the primary payer and there is a seconday payer (whos allowable is more) that we can only accept mcare payment minus any coins/ded? Does this make sense to anyone?

    Example.

    Mcare Primary Allw'd amt $552.94 and pays $442.36 coins: 110.58
    BC secondary Allw'd Amt 992.25 and pd $992.25

    From my understanding we only have to refund BC the overpayment of $442.36 (mcare pymt)

    My office manager is telling me that we have to refund $881.67 the difference between BC payment minus Mcare coins.

    Any help would be greatly appreciated.
    Sonja Little, CPC

  2. #2
    Location
    Hartford, CT
    Posts
    723
    Default
    This looks more like a coordination of benefits issue. If BC paid their full fee scedule they may think they're primary. Was a MSP questionaire done at the time of the visit? Before refunding any money I would get the COB straight, then look at who you have to refund.

    Doreen

  3. #3
    Default
    Quote Originally Posted by dclark7 View Post
    This looks more like a coordination of benefits issue. If BC paid their full fee scedule they may think they're primary. Was a MSP questionaire done at the time of the visit? Before refunding any money I would get the COB straight, then look at who you have to refund.

    Doreen
    That's exactly right. You should call Medicare's eligibility line and check Medicare Secondary Payer status, to make sure that Medicare is supposed to be primary. Then you may have to have the patient call BCBS and/or Medicare and update their COB. Sometimes BCBS will pay like they're primary when they're not (usually not with Medicare, though), and if they did that and it caused an overpayment, you would actually refund the patient, not the payers. That's a rare occurance, though - you should definitely verify that they made the correct secondary payment amount before refunding anyone.

  4. #4
    Default Also...
    Your office manager is right about the amount. You have to honor Medicare's allowable, regardless of what BCBS pays. The only amount that you can keep is the coinsurance amount - keeping any more would be equivalent to "balance billing", which is prohibited.

Similar Threads

  1. Medicare Secondary's allowance is higher than the primary's
    By CatchTheWind in forum Billing/Reimbursement
    Replies: 7
    Last Post: 04-29-2016, 11:52 AM
  2. Medicare primary with AARPUHC secondary
    By ajijon in forum Medicare Regulations
    Replies: 0
    Last Post: 03-10-2014, 09:50 PM
  3. Billing Primary when Secondary is Medicare
    By coop22 in forum Billing/Reimbursement
    Replies: 2
    Last Post: 02-26-2014, 07:01 AM
  4. Medicare Secondary Ins
    By nyyankees in forum Payer/Health Plan
    Replies: 2
    Last Post: 04-30-2013, 02:18 PM
  5. Medicare primary, commercial secondary
    By laharp4 in forum Medicare Regulations
    Replies: 3
    Last Post: 06-03-2012, 10:55 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.