jennsomers
Networker
I need some help with this. If I see a patient who has an OUT OF NETWORK carrier as primary and Medicare as secondary (I am par with only Medicare), am I required to submit to medicare even if the patient should be responsible in full for the billed amount according to the primary carrier?
I have asked medicare on numerous occasions what to do and I get a different answer from each person. Patients also call and get different answers and yet I am left stuck in the middle and confused.
Example:A patient has United Healthcare primary and Medicare secondary (for all purposes of this there are no deductibles and coinsurances involved)
UHC is billed $400.00 and paid $200.00. The patient is responsible for the other $200.00 as per the EOB. What is the right thing to do?
A) have the patient pay the $200.00 difference and they need to seek reimbursement from medicare on their own since we are following the primary carriers guidelines
B) I submit to medicare and the patient would owe the difference between what medicare paid and the $200.00 balance from UHC (but the mcr eob says there is no patient responsibility)
C) The patient pays the $200.00 and I somehow sumbit for the patient to be reimbursed by medicare.
D) another suggestion
I have looked for documentation without much success, the reps at Medicare just say to look in the manual, and all I see is "how to" submit a claim with no information about being out of network with the primary carrier.
Please help.
I have asked medicare on numerous occasions what to do and I get a different answer from each person. Patients also call and get different answers and yet I am left stuck in the middle and confused.
Example:A patient has United Healthcare primary and Medicare secondary (for all purposes of this there are no deductibles and coinsurances involved)
UHC is billed $400.00 and paid $200.00. The patient is responsible for the other $200.00 as per the EOB. What is the right thing to do?
A) have the patient pay the $200.00 difference and they need to seek reimbursement from medicare on their own since we are following the primary carriers guidelines
B) I submit to medicare and the patient would owe the difference between what medicare paid and the $200.00 balance from UHC (but the mcr eob says there is no patient responsibility)
C) The patient pays the $200.00 and I somehow sumbit for the patient to be reimbursed by medicare.
D) another suggestion
I have looked for documentation without much success, the reps at Medicare just say to look in the manual, and all I see is "how to" submit a claim with no information about being out of network with the primary carrier.
Please help.