decisionhealth Newsletters, Part B News - 2003 Issue 6 (June)
Send a secondary payer claim to Medicare when appropriate
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Article Overview
This article discusses Medicare secondary payer billing guidance for situations where a patient has both a primary insurer and Medicare coverage. It explains the general compliance importance of submitting Medicare claims even when the primary payer has paid in full, and it addresses how primary payments relate to deductible crediting and zero-balance claims. The article is aimed at billing and coding professionals who need a practical understanding of Medicare secondary payer procedures and related documentation considerations.
Why This Topic Matters
Correct handling of Medicare secondary payer claims affects compliance and ensures patients receive proper deductible credit. The topic matters to practices that bill Medicare after primary insurance has paid and need to understand when a claim is still required even without an expected Medicare payment.
What You Will Learn
- When Medicare secondary payer claims may still be required after primary insurance payment
- How primary payer payments can affect Medicare deductible crediting
- Why zero-balance claims may still need to be submitted
- How contractual acceptance of primary payer payment can affect remaining claim balance
- What broad circumstances may allow Medicare to pay a difference after primary payment
Who Should Read This
- Medical billers
- Coding professionals
- Revenue cycle staff
- Practice managers
- Compliance staff
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