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Medicare patient in Auto Accident/PI Case

  1. Default Medicare patient in Auto Accident/PI Case
    Medical Coding Books
    1) If a Medicare patient is in a car accident, are we required to bill the PI carrier only Medicare limiting charges (we are non-par) for covered services or can we bill our regular fees? This assumes PI coverage is still available.

    2) If the PI coverage is exhausted, do we then bill Medicare as secondary payer only the Medicare limiting charges?


  2. Default What we do
    I think,
    1) Where i work, a physical therapy practice, we participate with medicare and we still bill PIP coverage claims according to our own fee schedule and most times get reimbursed in full. So, if i were you, i would definitely bill the practice's charges.( they are, hopefully, more than Medicare's fee schedule)
    2) Medicare will always pay according to their limiting charges. So, if you bill them according to your practice's charges, you will only be writing off the difference.

    Will try to research and post links to supporting documentations.
    Hope it helps.

  3. #3
    you are required to bill auto first and yes bill reg charges if that gets exhausted then Medicare will pay per their fee schedule

  4. #4
    Concord, NC or Rochester, NY
    always, always, always bill Usual and Customary fees as this will keep you out of trouble and optimize reimbursement. If anyone every pays the U&C, then you need to increase it for that code as you are leaving $ on the table.


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