Hello. We recently saw an 88 y.o. Pt. She gave us a Medicare card and we saw her for the day of the visit. When it was time for me to drop the claim. I noticed that our EMR alerted us that Pt has a replacement Medicaid hmo. To make it short, Pt has a dual eligible Medicare replacement HMO. Pt was not aware of the change. We could not get an authorization from Humana because they said that we should ask for a PCP referral first. Pt has never seen her assigned PCP before, so they refused to give one. The PCP who referred her to us, refused to give us a referral as well. They said that they will not get paid either.
We are in-network with Regular Medicare, but not with Humana replacement Medicare. Can we bill the Pt? I plan to bill her the full amount, then ask her to coordinate with HumanaMedicare and ask them to reconsider. Is this a violation?
If Humana refuses, I plan to match what Medicare charges and charge the discounted bill to the Pt. Is this legal? Please advise. I am very new to billing. Thank you.
We are in-network with Regular Medicare, but not with Humana replacement Medicare. Can we bill the Pt? I plan to bill her the full amount, then ask her to coordinate with HumanaMedicare and ask them to reconsider. Is this a violation?
If Humana refuses, I plan to match what Medicare charges and charge the discounted bill to the Pt. Is this legal? Please advise. I am very new to billing. Thank you.