Otolaryngology Coding Alert

Question: Thanks for your article last month about appeals. One of the points was to check whether Medicare is primary before submitting a claim. How do we do that?

Florida Subscriber

Answer: Ensure that you ask every patient for all of their insurance cards when they present for a visit. Even if they only hand you a Part B Medicare card, be sure to ask whether they have any other insurance plans to give them the opportunity to think about any other plans they may have forgotten about.

Once you have the insurance cards, consult the CMS website or contact your MAC to determine which insurer pays first. For instance, the Part B payer in Florida — First Coast Service Options — has a chart indicating which payer should be primary and which should be secondary in a wide variety of scenarios. You can find First Coast’s chart here: https://medicare.fcso.com/MSP/208910.asp.

Alternately, you can use a third-party clearinghouse service that can verify patients’ primary and secondary insurance, as well as whether the patient’s deductible has been met and what the terms are of their insurance.