MCCONKEYT
Guest
I just got off a call to Novitas Medicare and how to appropriately handle billing Medicare as second when the primary insurance does not recognize G0461 & G0462.
I was told that it is not wrong or fraudulent to change the code to one of the G codes after the primary has paid. When Medicare is billed the EOB from the prime is sent. Medicare sees that EOB and how the primary processed the claim. And, of course, they see the different code. They will coordinate their benefits according to the information on the EOB. Desi said it is not wrong to change the code because they no longer recognize 88342. She did say that down the road should Medicare decide they have overpaid they will take back. (comforting thought) But it wouldn't be considered fraudulent billing. I know we were not the only ones scratching our heads over this one.
I was told that it is not wrong or fraudulent to change the code to one of the G codes after the primary has paid. When Medicare is billed the EOB from the prime is sent. Medicare sees that EOB and how the primary processed the claim. And, of course, they see the different code. They will coordinate their benefits according to the information on the EOB. Desi said it is not wrong to change the code because they no longer recognize 88342. She did say that down the road should Medicare decide they have overpaid they will take back. (comforting thought) But it wouldn't be considered fraudulent billing. I know we were not the only ones scratching our heads over this one.