Wiki When Medicare is secondary payer.

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ChristieH

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When a consult code (i.e. 99244) is billed and paid by the primary commercial payer, how does your office file the secondary claim to Medicare? Medicare does not allow consult codes any longer. Do you change the code to a comparable Medicare code and file it, or do you just turn the balance over to pt responsibility? If you have an answer or know where I can get the answer, it would be greatly appreciated.

ChristieH
 
I hope this is helpful. :)

"Medicare will also no longer recognize the consultation codes for purposes of determining Medicare secondary payments (MSP). In MSP cases, physicians and others must bill an appropriate E/M code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes, physicians and others billing for these services may either:

Bill the primary payer an E/M code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with the same E/M code, to Medicare for determination of whether a payment is due; or

Bill the primary payer using a consultation code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with an E/M code that is appropriatefor the service, to Medicare for determination of whethera payment is due."

http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/MM6740.pdf
 
Thank you for commenting. That is what I found as well, and to me, that says to bill an appropriate CPT code for Medicare and attach the primary EOB. I just needed to see it in writing.:)
 
Medicare secondary consult code

We billed to UHC Primary a consult code and it went towards patients deductible and we received no payment. The patient has Medicare as secondary and they do not recognize the consult codes. What do we do? I cant change the code because it really was a consult and we believe that would be fraud to change in order to get paid by Medicare.
Can we bill the patient what is do as if she didn't have Medicare?? I'm really in a catch twenty two! I feel like our physician should get paid. Any help would be appreciated.:
 
peggyyoung said:
We billed to UHC Primary a consult code and it went towards patients deductible and we received no payment. The patient has Medicare as secondary and they do not recognize the consult codes. What do we do? I cant change the code because it really was a consult and we believe that would be fraud to change in order to get paid by Medicare.
Can we bill the patient what is do as if she didn't have Medicare?? I'm really in a catch twenty two! I feel like our physician should get paid. Any help would be appreciated.:
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Per Medicare guidance, changing the consult code to a new/establ patient code after the primary payer has processed the claim is appropriate in this situation. See the Q&A page 5-6 here:

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/se1010.pdf
 
Need help with different billing requirements. Florida Blue processed and paid the claim. We follow BCBS guidelines place the CPT code on two separate lines. After sending the claim to Medicare the claim is denied as Medicare requires the service to billed on one line. Any suggestions on how to proceed?
 
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