Medicare Compliance & Reimbursement

Carriers may grant extension, vendors may be able to help.

If you haven't already received a shocking letter from your Medicare carrier about Medicare secondary claims, you may receive one soon.

Many carriers, including Noridian and Trailblazer, have been telling providers that they have to start billing Medicare secondary claims electronically. Often, these letters give a very short timeline to make the changeover. Chances are you're like many other providers who bill electronically except when it comes to Medicare secondary claims.

The problem: Some billing software isn't set up to handle Medicare secondary claims, say providers. Either you can't bill Medicare secondary at all, or you have to input all the information manually about what other payors have already paid. "We had to hold our claims for some time" until the software vendor was able to install a patch, says Natalie Watson, office coordinator with Anatomi Imaging.

Don't count on your software vendor to fix the problem in a hurry, providers warn. "After logging many calls to support and having them 'fix' [the software] we still can't send electronically," says Carolyn Stevenson with Gastroenterology Specialists of Oregon in Oregon City. Even after an upgrade, Stevenson must input the information by hand.

Request a delay: Merced Heart Associates in Merced, CA received a letter from NHIC giving an Aug. 29 deadline to start submitting claims electronically. Merced Heart wrote to the carrier and asked for a 90-day extension--and got it, says coder Mary Albert. The delay gave Merced Heart a chance to work with its vendor to iron out bugs in the secondary submission process.

Another problem: If your primary insurer doesn't accept electronic billing, then you still won't be able to bill Medicare secondary claims electronically, even if your own software works, Albert cautions.

Sometimes, the software comes up with an incorrect Medicare Insurance Type Code, the number that explains why the patient has Medicare secondary insurance, notes coder Lisa Blair. It often takes some trial and error to get it right, she adds.