decisionhealth Newsletters, Part B News - 2010 Issue 4 (April)
3 tips to maximize consult dollars when Medicare is secondary payer
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Article Overview
This article discusses billing workflow choices for consultation services when Medicare is secondary and a private payer is first in line. It focuses on how different claim-handling approaches affect payment, staff effort, and claims processing efficiency. The guidance is aimed at coders, billers, and practice managers who handle consultation and office/outpatient evaluation and management claims.
Why This Topic Matters
Understanding the claim-flow implications of consult billing can help practices avoid unnecessary rework and better anticipate payment differences when Medicare is not the primary payer.
Article Sections
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Billing approaches when Medicare is secondary payer
Introduces the two claim-handling approaches discussed for consultation services when Medicare is secondary. The section frames the payment and workflow tradeoffs that follow.
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Factors to consider when choosing an approach
Outlines the broad practice considerations used to decide between the available billing workflows. Topics include consultation volume, patient status, and claims processing setup.
What You Will Learn
- How consultation billing differs when Medicare is secondary versus primary
- What workflow considerations can affect payment and staff effort
- Why practice structure and patient type may influence billing approach decisions
- How claims processing systems and clearinghouses can affect reimbursement workflow
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle teams
- Specialists and surgeons
- Primary care practices
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