Wiki MEDICARE SECONDARY PAYOR W/C INSURANCE

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kcowan

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WE SAW A PATIENT JANUARY OF 2022, WE FILED TO MEDICARE BUT MEDICARE DENIED BECAUSE THERE IS A W/C INSURANCE THAT SHOWS THEY ARE PRIMARY. WE HAVE REACHED OUT TO THE PATIENT AND HE SAYS IT WAS SUPPOSE TO BE FIXED FILED AGAIN TO MEDICARE DENIED AGAIN. AT THIS POINT CAN WE BILL THE PATIENT FOR THE BALANCE?
 
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The EOB with the denial from Medicare should tell you whether or not you can bill the patient. If it says that the patient is not responsible for the charges, then you have to abide by that.
 
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Medicare can take up to 10-15 days to update their system with any changes in COB info. Bill it again to Medicare and see if they will pay - which they should if it was updated. If it isn't you need to notify the patient again. I come across this all the time. I have also sent in reconsideration via Connex that this treatment is not related to the w comp injury and got payment. I have several patients that we treat the body part that is workers comp but it the treatment is for something else, so appealing works in these cases.

Good Luck!
 
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Melissa Harris CPC said:
Medicare can take up to 10-15 days to update their system with any changes in COB info. Bill it again to Medicare and see if they will pay - which they should if it was updated. If it isn't you need to notify the patient again. I come across this all the time. I have also sent in reconsideration via Connex that this treatment is not related to the w comp injury and got payment. I have several patients that we treat the body part that is workers comp but it the treatment is for something else, so appealing works in these cases.

Good Luck!
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What is the via Connex?
 
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You can file to Medicare with the 837 Remark in box 60 on the UB04 "Admission unrelated to Workman's Comp". This worked for me.
 
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