Medicare is not always the primary insurance payer. As such, they review claims to see when they inappropriately paid as the primary payer when they should have been the secondary. It is essential for providers to clearly establish the Medicare status of a patient on the initial encounter and reviewed annually.
See Chapter 2 - Medicare in Find-A-Code's specialty-specific Reimbursement Guides or the ChiroCode DeskBook for more information about this important topic. Additionally, FindACode has created a Medicare Status Questionnaire Form (see "Resources/Links" tab) which is completed by the patient and helps to establish which payer is primary.
General Links and Resources
General Billing Requirements
Ch. 1 Medicare Claims Processing Manual
Select the title to see a summary and a link to the full article.
August 20th, 2019
Are You Aware of Medicare Advantage Plans Timely Filing Rules?
Published August 20th, 2019|
The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...
February 25th, 2019
Medicare Supplemental Policies (MediGap) and Extremity Adjustments
Published February 25th, 2019|
The nice thing about MediGap policies is that they pay for some of the healthcare costs that an original Medicare plan (Part B) does not cover. So when a patient has Medicare and a Medicare supplement (MediGap) and their condition is related to an extremity (a noncovered service), Medicare must ...
January 15th, 2018
Billing with a GP Modifier
Published January 15th, 2018 - Last Review/Update January 30th, 2019|
Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?
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