# Any billing regulations?



## smoore0808 (Mar 6, 2013)

Does anyone know if there is a Medicare billing regulation that states you HAVE to bill secondary to Medicare insurances (commercial) the coins or copays left by Medicare? 

Patient has a pro fee claim, Medicare processed but it didn't cross over to the secondary automatically and the coins left on the claim is $1.75 to be billed to commercial (aetna). Our small balance write off is 9.99 so instead of billing the secondary insurance we submitted an adjustment to the small balance write off.

Are we ok doing this if we do it across the board for all payers? If we choose not to get reimbursed by the secondary, is that really our choice? If we didnt bill the secondary we wouldnt bill the patient either.

Thank you,

Sarah


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## mdemings2 (Mar 6, 2013)

*Medical Biller*

Is there a reason you don't want to bill the secondary for payment. What if you bill the secondary to aetna and they pay primary? would you want to get this fix at that time other then later? I don't really think you need to write that claim off with out billing the secondary. just my opinion.


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## smoore0808 (Mar 7, 2013)

That was my thought too but my Director believes that it would cost more to bill to the secondary in my billers time than doing the adjustment for small balance in line with the small balance adjustment policy. 

This has been ongoing because of all the Medicare reprocessing of accounts and them changing the coins on accounts and leaving an additional $$ due from the secondary insurances.

I just wanted to make sure we are not violating any regulations by adjusting off the small balance instead of billing it. If she doesn't want the reimbursement I will let her decide that I just want to make an informed decision.

Thank you,


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## pjorwin (Mar 24, 2013)

As far as I know there is no obligation to bill any Medicare coinsurance/secondary coverage. Since there is a difference between a supplement plan and an indemnity not all of them crossover, therefore unless you verify the 2nd coverage you will not know if it is a secondary or a supplement. To my knowledge, it is against Medicare guidelines to 'write off' any MEDICARE coinsurance; all patients should be treated equal no matter what the dollar amount is of the coinsurnace. If your office does not want to bill coinsurance they will need to ask/bill the patient for the amount due for services and not check the box stating you have signature on file for coinsurance payment to be sent to you. I hope this answers your question. By the way, yes it is violating Medicare guidelines. Check with CMS.gov.


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## mgord (May 23, 2013)

We have had this same issue come up and our administrator says they are paying more in postage than what is even due on these claims and that we should just set up an automatic adjustment to adjust these off as small balance. I wasnt even aware that you could set up an automatic adjustment for a small balance write-off. We are a small practice with 4 providers and a PA. My concern is what if we set up this automatic adjustment and something was posted wrong or needs to be corrected somehow, we would never know because it would automatically be adjusted.


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## CODER46 (Jun 12, 2020)

i have a question that may seem primitive to you all but I am trying to locate billing regulations in the coding books if not there then where please help thanks


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## SharonCollachi (Jun 12, 2020)

CODER46 said:


> i have a question that may seem primitive to you all but I am trying to locate billing regulations in the coding books if not there then where please help thanks



I would suggest you start a separate discussion or this will likely be missed.  You also might want to narrow down the question a tiny bit.


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