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Secondary Insurance Issues

  1. #1
    Greater Pittsburgh Chapter
    Default Secondary Insurance Issues
    Medical Coding Books
    A patient initially ony presented his primary commercial insurance. His initial visit was a consult 99243 he also had audio testing done and it was billed incident to under the physician. We received proper reimbursement and patient had a deductible balance he is responsible for.

    At his next visit, he brought the bill and his Medicare card with him stating that Medicare is secondary and to send this balance on to them.

    The initial codes used and paid by the insurance do not comply with CMS guidelines. Do I need to file a CC to the primary insurance with the CMS appropriate codes before I can file to secondary Medicare? Or is there a more efficient way to handle this situation?

    Thank you,
    Beverly Andrews, CPC

  2. Default Msp
    Medicare offers 2 options for billing this claim. Here is a link to their question and answer page regarding billing consults to Medicare as the secondary payer.
    You can either bill it with the original code or change it to a code medicare recognizes. Their system has been updated to process either way


  3. #3
    Greater Pittsburgh Chapter
    Thanks much for your help!

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