Wiki Billing pt for Medicare (sedondary) deductible

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marthaarr@qwestoffice.net

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Please advise!! I think this should be an easy question to answer, but I have spent the last hour trying to find an answer to my question. We have a patient who has commercial primary, medicare secondary, as disabled beneficiary under 65. Her primary paid her office visit, with a $30.00 co pay due. Which we billed to Medicare, and they applied to deductible. Can we bill the patient? There is conflicting information on the Medicare EOB. One lists, $32.21 as patient responsibility, and another (for a different date of service) Medicare EOB lists $0 patient responsibility. I am so confused! I am an old school biller/poster, and "back in the day" we never took an adjustment on a secondary payor that applied to deductible, and we would bill the patient for the deductible. I am very appreciative of any advise I could get!
Thanks all!

Martha
 
Hi Martha,

You want to reference the patient responsibility line to find out if you can bill the patient or not on the Medicare EOB and not the deductible/coinsurance columns. Medicare takes into consideration the primary insurance payment so the columns can read an amount different than what the patient responsibility line states.

Ex: A Medicare EOB can state deductible $108.00 under the deductible column but over on the patient responsibility it will state "Patient Responsibility: $0.00". Here Medicare is stating they are taking the primary insurance payment as satisfying the $108.00 deductible so the patient is not responsible for it (which explains why they have pt resp as $0.00). So you will not bill the patient, even if their is an amount left over. In our office we would adjust this off as a secondary adjustment.

Also, not sure if you know this or not, Medicare will pay as primary if the patient's primary insurance did not make a payment to a charge. If a primary insurance did not make a payment at all but applied a contractual and applied it to the deductible, Medicare will pay as primary if the payment turns out to be less than the allowable amount of the primary. In this example, the deductible/coinsurance columns will match the "patient responsibility line" and you can bill the patient this amount.

Hopefully I didn't confuse you more, let me know if you have more questions.

Lisa
 
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