Anesthesia Coding Alert

Start with all insurance cards, not just Medicare.

Anesthesia providers don't often see patients in the office, but your office staff plays an important role in making sure claims get paid. If your practice audits show errors from billing Medicare Secondary Payer (MSP) claims as primary, read on for the latest CMS instructions for MSP filing success from a recent MLN Matters article.

1. Verify all of the patient's insurers. Get copies of all the patient's insurance cards. Sometimes a patient might present his Medicare identification card, but not the cards for additional payers. This could cause unnecessary denials if you're inappropriately billing Medicare as primary. The opposite situation can also throw a kink in your coding. "If the patient is of Medicare age and the Medicare information isn't provided, the patient may have MSP," says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl.

2. Bill the primary payer first. You can't submit claims to the patient's primary payer and the MSP at the same time. Instead, you must bill the primary payer and then wait for the remittance advice from that insurer before you submit to the MSP.

3. Single out accident claims. If your patient has an open MSP liability, no-fault, or workers' compensation record, you should bill those payers first, but do not deny treatment, CMS advises.

You'll submit to the accident payer first (for instance, the workers' comp insurer), and then to MSP with the first payer's remittance information. If the accident payer did not pay you for the accident-related services, "Medicare will need this information to process your claim accordingly," the MLN Matters article notes. "If you follow these procedures, you do not need to wait 120 days to submit your claim to Medicare for payment."

"Be alert to clues on the demographic information provided by the hospital," Dennis advises. "For example, if the procedure is resulting from an accident, there may be a liability carrier involved (automobile, worker's compensation for working elderly, etc.)."

4. Include EOB with paper claims. If you're not yet billing electronically, remember to include the primary payer's explanation of benefits (EOB) when you submit your paper claim to the MSP, notes a CGS Medicare directive from last summer.

Resource: To read the complete MLN Matters article, visit http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1217.pdf.