Ophthalmology and Optometry Coding Alert

Turns out if Medicare is secondary, you might not have to file the claim.

An article in Ophthalmology Coding Alert, Volume  12, Number 6, "If Medicare Is Secondary, Don't Bill Patient," said that "if the patient has Medicare as hissecondary insurance, you are required to submit the claim to Medicare per the laws and regulations of your participation contract with Medicare." However, according to the "Exceptions to Mandatory Filing" found in the Medicare Physician Guide, providers and suppliers are not required to file claims on behalf of Medicare beneficiaries when "the claim is for services for which Medicare is the secondary payer, the primary insurer's payment is made directly to the beneficiary, and the beneficiary has not furnished the primary payment information needed to submit the Medicare secondary claim."

More information: The Medicare Physician Guide is available at www.cms.hhs.gov/MLNProducts/downloads/physicianguide.pdf.