Pulmonology Coding Alert

Question: We have a patient with a Medicare Advantage secondary/supplemental policy. We are unable to locate his Part B information — can we just bill the MA payer?

South Carolina Subscriber

Answer: Yes, you should bill the Medicare Advantage (MA) insurer and not worry about Part B at all. That’s because an MA plan is an alternative to Medicare’s traditional Part A and Part B programs — rather than being a supplemental or secondary policy.

With a supplemental policy, a patient is covered by Medicare Parts A and B, and then also gets a secondary, supplemental policy to pay for out-of-pocket costs that Medicare won’t cover.

An MA plan, on the other hand, replaces Parts A and B. Medicare Administrative Contractors (MACs) do not process MA claims. You’ll instead send MA claims to the Advantage contractor.