tci Medicare Compliance & Reimbursement - 2006 Issue 39
PART B: Check Secondary Coverage Before Charging Patient For Preventive Services
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Article Overview
This article discusses how Medicare coverage interacts with secondary insurance when billing preventive services for Medicare beneficiaries. It focuses on the need to verify payer order, obtain the appropriate Medicare denial before secondary processing, and understand that supplemental plans and Medicare managed care products may differ in what they cover. The piece is aimed at billing staff, coders, and practice managers who handle preventive service claims for Medicare patients.
Why This Topic Matters
Preventive-service billing for Medicare patients can depend on whether the patient has supplemental or managed-care coverage that may pay after Medicare denial. Understanding the coverage sequence helps practices avoid incorrect patient collection and improves claim handling.
What You Will Learn
- How Medicare and secondary coverage can interact for preventive services
- Why payer sequence matters before secondary processing
- How supplemental coverage types can differ
- Why local carrier rules and Medicare managed care plans may affect preventive-service coverage
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Front-desk and patient account staff
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