Medicare, Medicaid, Life and Health Insurance/Medicare secondary

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Question
The only insurance our office participates in is Medicare. Recently some patients have Medicare secondary. What are the rules for patient billing? Do we need to accept Medicare allowable even though we do not participate with the primary insurance?

Answer
Yes, you must accept the Medicare payment. As a participating Medicare provider, you have agreed to accept the Medicare allowable. This means you cannot bill the patient for more than the patient's Medicare deductible, copay or coinsurance amounts. Medicare will inform you on the Medicare Remittance Advice of the amount that can be collected from the patient. Be sure when filing your MSP claim that you follow Medicare Secondary Payer billing guidelines for accurate payment processing.  

Medicare, Medicaid, Life and Health Insurance

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Joy B. Hicks, MBA, CPM

Expertise

As a Medical Office Expert, I can answer any question related to the medical office from the prospective of hospital and physician office staff and patients.

Experience

I have been in the medical office field for 12 years and also have a blog that provides advice, information, and tips about the medical office.

Publications
medicaloffice.about.com
askamedicalbiller.com
allthingsmedicaloffice.blogspot.com

Education/Credentials
Certified Practice Manager
AAS Business Administration
BA Health Care Administration
MBA w/ healthcare specialization

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