Practice Management Alert

Question: I have a claim from 2001 that was paid by an insurance carrier. They have just now retracted their payment as "Medicare Primary." Obviously, Medicare will deny the claim because it is past the timely limits. We, as the provider, should not have to write off these charges because the insurance company failed to retract its  payment in a timely manner, but an appeal to Medicare will most likely be denied. Can we take this up with the insurance company on the basis that it waited too long to retract its payment? 

New York Subscriber
 
Answer: You should probably do two things, says Jennifer Darling, insurance and collection specialist with the Center for Oncology Research and Treatment in Dallas:
 
1. Deny the refund to buy some time - you may or may not include the fact that you are awaiting payment from Medicare - and tell the insurance company that when/if you receive payment from Medicare you will forward its refund.
 
2. Bill Medicare with a letter explaining the situation and a copy of the notice from the insurance company that wants its money back. It will be obvious to Medicare that you filed the claim timely, just to the other carrier. Sometimes Medicare will take this into consideration and process the claim, taking only a late-filing deduction from your payment. 
 
"I've had this happen, and Medicare did pay," Darling says. "Our claims were from January and February of 2002, and we just received payment in September 2003."
 
"We have had this situation happen several times," says Cathy Barton, Medicare billing coordinator at Spokane Cardiology in Spokane, Wash. First you might just want to submit the claim to Medicare, she says. "They might be aware of the situation already and pay on the claim accordingly," applying a timely filing fee, but paying nonetheless. If it's denied, Barton then recommends appealing in the manner that Darling describes, attaching an explanation and the retracting letter from the other insurance company. "This generally will get the claim paid," she says.