decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Medicare_Secondary_Payer_Billing_Rules / Accepting_primary_payment_as_full_payment
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Article Overview
This article covers a Medicare Secondary Payer billing scenario involving coordination with a primary insurer, claim submission to Medicare, and handling of balances when the primary payment is accepted as payment in full. It is aimed at providers, billing staff, and revenue cycle professionals who need to understand how these payer arrangements affect Medicare claims and deductible crediting.
Why This Topic Matters
Understanding this scenario helps billing teams avoid inappropriate secondary billing, preserve proper deductible crediting, and recognize when payment received from Medicare must be returned if it was not due.
What You Will Learn
- How primary insurer agreements can affect the remaining balance on a claim
- Why a zero-balance claim may still be submitted to Medicare
- How Medicare deductible crediting is handled in this type of billing situation
- What to do if Medicare pays a claim that should not have been paid
- How billing differs when there is no contract to accept the primary payer’s payment as full payment
Who Should Read This
- Medical billers
- Coding professionals
- Revenue cycle staff
- Practice managers
- Healthcare providers
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