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need help with secondary billing!!

  1. #1
    Question need help with secondary billing!!
    Medical Coding Books
    I have a question, when a pt has a secondary insurance and they allow less than the primary insurance did, so they do not pay the copay, do you have to write that off or can you bill it to the patient?

  2. #2
    Location
    Tacoma, WA
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    1,087
    Default
    Quote Originally Posted by cglasg2151 View Post
    I have a question, when a pt has a secondary insurance and they allow less than the primary insurance did, so they do not pay the copay, do you have to write that off or can you bill it to the patient?
    You compare the write off for the primary and the secondary, whichever is larger is the total write off after payments. In some cases that means that the patient will not owe a copay. Example: Total charge = $200
    1st ins allows-$190 (write off $10) then pays 175 leaving a $15 copay.
    2nd ins allows-$175 and pays nothing due to primary payment (pt owes
    nothing since the allowed by the seconary is lower than the primary)

    The total fee charged was $200 - the larger write off is the 2nd ins $25 and the primary paid $175 - so patient owes nothing.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Default Secondary
    If the patient has a secondary is it a supplement? Why would the provider be concerned with the allowed amount of the secondary unless it is a government program? I bill the patient for the total allowed amount of the primary. If the secondary does not pick it up then bill the patient. If not done set a policy in the practice on how to handle a situation like this.
    I say bill the patient.

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by pmirolo View Post
    If the patient has a secondary is it a supplement? Why would the provider be concerned with the allowed amount of the secondary unless it is a government program? I bill the patient for the total allowed amount of the primary. If the secondary does not pick it up then bill the patient. If not done set a policy in the practice on how to handle a situation like this.
    I say bill the patient.
    If you are contracted with both insurances you cannot bill the patient. You must look at the allowed amounts on both plans and take whichever write off is larger. Then minus whatever payments are made the patient may or may not owe a balance. In general with two insurances, most patients do not owe balances after payments and write offs.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #5
    Red face
    Thank you very much!!!

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