Wiki LPC Billing Question

[GMMTimmons]

Our LPC (Counselor) has a patient that has Medicare as Primary and Blue Cross as Secondary. The LPC cannot bill Medicare. So how do we get the secondary to pay for the visit without the Medicare EOB?

 

[SharonCollachi]

You don't. The patient has to follow the rules of the primary insurance, which is to see someone on their panel.

 

[rchehey]

For our DO office, we have opted out of Medicare so because we can't bill to medicare, there is not a denial. So for us to bill blue cross, we have to file it with our opt out letter from noridian Everytime. However blue cross will only pay out as a secondary insurance (usually 20% of the medicare rate). There is a contractual adjustment but it leaves the patient with about ~50-60% of the amount due by them. I also asked blue cross and they said that because we can't bill medicare, the patient can submit it to blue cross themselves with an opt out letter and they would payout about the same, as a secondary insurance.
But we have to be careful doing it this way, as our discount needs to be equal to or greater than what the contractual adjustment would be or else we would owe the patient the difference.