Practice Management 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 it is illegal for you to bill him and not Medicare.

When Medicare is the secondary payer, you are still restricted to the rules and regulations governing the billing and collecting for services based on your contract agreement with Medicare. Keep in mind also that under no circumstances can you collect more from the patient than Medicare allows for the service, even if Medicare is secondary.

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.

Keep in mind that there have been problems since the move from the carrier system to the MAC system. Do not assume that a payment problem that you are having is a permanent one and that it is systemic or that you have done something wrong. Talk to your MAC, and if you do not get satisfaction at that level, go to your regional CMS office and talk to them about getting the issue worked out. Your MAC should be paying your Medicare secondary claims properly and you should not be jumping through hoops to get them paid.