Outpatient Facility Coding Alert - 2017 Issue 13
Reader Question: Can You Bill Medicare Even If You Aren't Enrolled?
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Article Overview
This short billing Q&A addresses a coordination-of-benefits scenario involving Medicare and Medicaid when a practice is not enrolled with Medicare. It is aimed at billing staff and practice administrators who need a general understanding of whether a claim can still be submitted and what to verify first before proceeding with secondary payer processing.
Why This Topic Matters
The article is relevant for practices that occasionally see patients with multiple coverage sources and need to understand how Medicare participation status can affect claim handling.
What You Will Learn
- How a Medicare-related claim issue can arise for an otherwise non-Medicare-enrolled practice
- Why confirming individual physician enrollment status matters in a billing workflow
- How claim handling may affect downstream processing by another payer in a dual-coverage scenario
- What type of billing situation this reader question is addressing
Who Should Read This
- Medical billers
- Practice administrators
- Orthopedic practice staff
- Revenue cycle staff
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