Patient submission of claims can get you into hot water

Why This Topic Matters

Understanding who should submit a claim and when helps practices stay aligned with Medicare filing rules and avoid avoidable claim-handling issues. The article also highlights CMS guidance that affects how noncovered or potentially denied services are reported.

Article Sections

1. Medicare claim filing and patient-submitted claims

   Covers Medicare primary payer filing expectations, patient-submitted claim activity, and the CMS guidance discussed in the article. The section also addresses circumstances in which patients may submit claims directly.

2. Secondary payer claim handling

   Discusses how Medicare secondary payer claims are handled when primary insurance information is involved. The section focuses on the general filing responsibilities described in the source.

3. Billing guidance for noncovered or denied services

   Reviews CMS guidance on claim submission when a service may be noncovered or denied and mentions the related modifier references included in the article.