RE: More Secondary Questions

[Guest guest]

I always bill the secondary.  I

don’t want to have to deal with refunds.  I’d rather try to collect

the small amount from the patient at their next visit.  Until I know what the

secondary does/doesn’t cover, I will always bill the secondary.  Most of

them cover the Medicare co-insurance in full.  A few (UHC, for one), will

require the patient meet their “deductible” or that they do owe for

a copay.  We just had one of those come in this morning.  She has a $5 copay on

her secondary.  I billed 2 visits for her, now she has a $10 balance owing, and

now I have a note on her demographics that says to collect the $5 copay at the

time of service. 

And, yes, I’m sure that

there’s some legal problem with saying that the patient is responsible

for amounts less than $X, because the patient is truly only responsible for

what their secondary doesn’t pay.  Sometimes it will be $5.  Sometimes it

will be $100.  You can’t tell until you’ve done a few FOR THAT

PATIENT ONLY.  Because God knows that the insurance companies have to keep us

on our toes and guessing as to what patient has which plan. 

If you are not required by your contracts

to bill the secondary, then I would not accept assignment for secondaries and

have the patient pay you directly.  The easiest way to do that is to require

credit card authorizations that you can automatically charge when you get the

Medicare EOB.  Or, you can collect at the visit: you will know what 20% of the

visit will be.  It’s always the same, by CPT code.  Here, the balances

are $21.05 for a 99214 and $14.something for a 99213.  Of course after 1/1, you

have to collect the deductible, which you won’t know if it’s

already been paid or not unless you call Medicare.  It’s a

mess….not easily fixed. 

But if your contracts require you to bill

secondary claims, too, then I’d focus on making sure that the patients

have informed Medicare of their secondary and that it is set up to

automatically cross over.  Then you don’t have to do anything until the

EOB’s come back from the secondary.  That’s the majority of our

patients, and it’s much easier.  My only “problems” are the

HMO secondaries that Medicare can’t seem to get right in their system and

they bill the insurance company instead of the IPA.

(putting on my red super-hero suit

for anyone in need!)

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of kristina_arnp

Sent: Thursday, August 20, 2009

8:03 AM

To:

Subject:

More Secondary Questions

Sorry if this is extending the secondary conversation

too much...

Is there a legal problem (so many rules!) with saying that the patient is

responsible for amounts less than $X? For example, patient comes in and has a

copay of $15, could they pay that at time of service and take the receipt to

the secondary for reimbursement? Or is that going to totally mess up the books

when the co-insurance does not pay the full amount? Will the moon and stars

every line up to make this easier -- UGH! Pratt -- you are my hero!!

a Garrido, ARNP -- biller in training

www.villagefamilyclinic.com

>

> Rene:

>

> I am no expert, but my understanding is that if you have submitted an

appropriate claim to the secondary and you have not been paid in 30-60 days

(check your contracts if you are contracted with them), then the patient is

then the responsible party. Don't we all have financial policies that remind

the patient that they have the ultimate responsibility for the charges? I would

consider billing the patient after a certain period of time if the secondary

has not fulfilled their obligation- as long as you are sure that you have

submitted to them properly.

>

> Carla Gibson FNP

> Missoula, MT

>

>

>

>

> ________________________________

>

> To:

> Sent: Wednesday, August 19, 2009 9:44:34 AM

> Subject: Re: Secondaries

>

>

>

>

>

>

> thanks for the info. It seems like you get paid fast. we have several

(like 50) secondaries that are 120-600 days out and have been sent two or three

times. I think we need to just give up on a lit of these but it is maddening because

there is nothing that we can do with these companies when they just delay and

lose things.

>

> Rene

>

> >

>

>

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> " He is no fool who gives what he cannot keep to gain what he cannot

lose "

>