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Insurance run-around

  1. #1
    Exclamation Insurance run-around
    Medical Coding Books
    Scenario: Pt presents with a medicare card and a medicaid card, the front desk verifies coverage with medicare. Billing dept bills medicare, there were problems getting claim thru to medicare, finally goes thru, medicare denies as there is another payer. The time has run out to bill the other payor. Is there any way to appeal this?
    How can I keep this from happening? Is there a way to make it easier for the front desk to understand what information they need to get from the patient? (and then they can verify the right insurance) After I get a denial, I'm using typically 3 different websites to try and figure out who is prime, who is 2ndary etc. to bill it correctly.
    I know that pt's often are not aware of who is primary who is secondary, what is the replacement plan and so forth, but I get alot of patients who only give us 1/2 of the information we need to bill correctly.
    What are other people doing that they are finding useful in these types of situations?

  2. Default
    If you can show proof to the primary insurance that the claim was billed within their time limits to Medicare, the primary insurance should pay. Our state's Medicaid card has the primary, secondary insurance information on them. If the patient does not have Medicaid I bill the patient. Patients need to be aware of their insurance coverage. Once the patient gets a statement or a collection notice, this usually gets resolved.


    Robin King, CPC

  3. #3
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by bkwrmz7 View Post
    Scenario: Pt presents with a medicare card and a medicaid card, the front desk verifies coverage with medicare. Billing dept bills medicare, there were problems getting claim thru to medicare, finally goes thru, medicare denies as there is another payer. The time has run out to bill the other payor. Is there any way to appeal this?
    How can I keep this from happening? Is there a way to make it easier for the front desk to understand what information they need to get from the patient? (and then they can verify the right insurance) After I get a denial, I'm using typically 3 different websites to try and figure out who is prime, who is 2ndary etc. to bill it correctly.
    I know that pt's often are not aware of who is primary who is secondary, what is the replacement plan and so forth, but I get alot of patients who only give us 1/2 of the information we need to bill correctly.
    What are other people doing that they are finding useful in these types of situations?
    Usually if you are verifying coverage with Medicare or Medicaid the information on other coverage is listed. I am not sure how your front desk verifies the Medicare coverage. I would have also verified the Medicaid coverage just to be sure I had all coverages listed. In Washington state the Medicaid website will show all other coverages on the patient. You can appeal to the primary payor by showing you billed timely to the insurance coverage you had on file. Let them know the patient did not disclose their additional coverage at the time of service. You might have to appeal up to the higher levels at the insurance carrier. There are no easy answers.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  4. Smile Insurance Run Around
    The front office or whomever handles the insurance verification should be able to verify Medicare benefits online. The section under MSP will indicate if Medicare is the secondary and supply the information for the primary payer.

    Sounds like your front desk may need an In-Service on what is required and how it can affect the billing processes. Sometimes we assume what they know and if they have not been trained properly that is all it takes.

    Good luck!

    Tricia Bergen

  5. #5
    Default
    If the office has numerous Medicare patients, I would suggest attempting to see if the office can obtain eligibility verifications direct from Medicare's website. They will be more accurate and most likely will include any other insurances as well as a clarification on who is primary. Takes less time to enter in the ID# and member information and verify. Offices and supervisors can obtain a master ID and password and then assign other users and passwords to employees as needed. It doesn't cost anything to sign up either.
    Just a suggestion.

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