ED Coding and Reimbursement Alert

Question: When a patient comes to the ED for treatment following a motor vehicle accident, should we be billing the patient’s medical insurance, automotive insurance, or both?

Nevada Subscriber

Answer: When your provider sees a patient who has had a motor vehicle accident (MVA), you run the risk of billing the wrong insurance company if you don’t investigate the patient’s coverage and your state’s regulations.

Warning: Don’t just assume that the patient’s health insurance is primary over the auto insurance and that you should bill the health insurance as primary and auto insurance secondary.

Your state will have regulations about billing auto insurance, so be sure that you know your state’s laws. For example, in some states, the motor vehicle laws state that a provider must notify the motor vehicle insurance within three weeks of the accident with a claim. You’ll also have to provide the physician’s note, but you have longer to do so.

Good practice: Ask the patient for all pertinent motor vehicle insurance information — name and phone number of claim adjuster, date of accident, claim number, and policy number — as well as their medical insurance information.

Although the patient’s auto insurance may provide coverage at first, benefits can run out and cause you to switch over to billing the patient’s private health insurance. And some patients may have a deductible with their motor vehicle insurance that needs to be covered by their primary health insurance.

Tip: Ask if the patient’s MVA was work-related. Many jobs require driving, and workers’ compensation — not motor-vehicle insurance — may pick up the tab if an MVA was work-related.

Vital: When you’re billing Medicare for MVA patients, remember to fill out boxes 10b and 14 on the CMS-1500 form. Check “yes” in box 10b if the patient’s condition was caused by an auto accident.

Under box 10b, there is a space for a two-letter state abbreviation. Be sure to write the state where the patient’s MVA occurred in this space.