b3ckalano
New
Hello there!
I am a relatively new biller and feel completely out of my depth trying to navigate Medicare, and can't get info from them directly either. I was hoping there may be someone who has handled this scenario before:
I work for an LPC who never enrolled with Medicare (PAR/nonPAR/Opt-out) because from her understanding, LPCs can't enroll. Now, she has a patient who has Medicare, Commercial insurance, and then Medicaid. We can't get the secondary/commercial insurance to pay because we can't get a Medicare EOB, and we can't get the tertiary/Medicaid to pay because we can't get an EOB from the secondary/commercial insurer.
-From what I've found, LPCs can enroll in Medicare, but they won't pay for their services. Correct?
-Can we even enroll as PAR? If they won't pay out, might as well enroll as non-PAR or Opt-out, right?
-If we go Opt-out, does the patient need to sign the Opt-out waiver still (even if we know Medicare won't pay out for LPC services, anyway)?
-If we enroll and are able to send in a claim to Medicare, but they don't pay because they don't cover LPC services - doesn't that mean the secondary/commercial insurance won't have to pay, either? (Generally, I understand some payers may have exceptions)
It's so complex it feels like there's an elephant in the room but I can't see it - so if I am missing a huge piece of the puzzle please let me know.
THANK YOU THANK YOU THANK YOU!
I am a relatively new biller and feel completely out of my depth trying to navigate Medicare, and can't get info from them directly either. I was hoping there may be someone who has handled this scenario before:
I work for an LPC who never enrolled with Medicare (PAR/nonPAR/Opt-out) because from her understanding, LPCs can't enroll. Now, she has a patient who has Medicare, Commercial insurance, and then Medicaid. We can't get the secondary/commercial insurance to pay because we can't get a Medicare EOB, and we can't get the tertiary/Medicaid to pay because we can't get an EOB from the secondary/commercial insurer.
-From what I've found, LPCs can enroll in Medicare, but they won't pay for their services. Correct?
-Can we even enroll as PAR? If they won't pay out, might as well enroll as non-PAR or Opt-out, right?
-If we go Opt-out, does the patient need to sign the Opt-out waiver still (even if we know Medicare won't pay out for LPC services, anyway)?
-If we enroll and are able to send in a claim to Medicare, but they don't pay because they don't cover LPC services - doesn't that mean the secondary/commercial insurance won't have to pay, either? (Generally, I understand some payers may have exceptions)
It's so complex it feels like there's an elephant in the room but I can't see it - so if I am missing a huge piece of the puzzle please let me know.
THANK YOU THANK YOU THANK YOU!