Ophthalmology and Optometry Coding Alert

Question: Getting Medicare to pay when it is the secondary payer is difficult. Can we just stop billing Medicare and collect from the patient instead, having the patient file the secondary claim?

Arizona Subscriber

Answer: You should not bill the patient directly. If the patient has Medicare as his secondary insurance, you are required to submit the claim to Medicare per the laws and regulations of your participation contract with Medicare. This applies whether you are considered "par" or "non-par" with Medicare.

Private payer difference: If the patient has a nongovernmental program as his secondary coverage, you may bill the patient and let him submit the secondary claim. If you are having trouble with your Medicare secondary payments, you should contact your Medicare MAC and find out why. There may have been a glitch in the system when your local carrier changed to a MAC. The transition from the carrier system to the MAC system has caused problems. If you do not get satisfaction at that level, talk to your regional CMS office.

Resource: Review the Medicare Secondary Payer Manual, Chapter 3, Section 30, at www.cms.hhs.gov/manuals/downloads/msp105c03.pdf for specific instructions for submitting Part B MSP claims.

-- Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, consulting manager for Pershing, Yoakley, and Associates in Clearwater, Fla.