Medicare question
Hello all,A client came in our facility with Medicare primary and BCBS secondary. I have to get a denial EOB or remittance from Medicare to send to BCBS and they won't send it because we are not a...
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You may be able to send a paper claim and might get a letter from Medicare stating that you are not a provider that may help. My question is did you inform the patient that you are not a Medicare...
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To be honest, we dont have enough information. We've been told the doctor is not enrolled with Medicare. We dont know if the provider opted out and we dont know if the doctor didnt accept assignment...
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Thank you for your responses and sorry for my not giving more information in my original post. We are a participating provider with BCBS and accept assignment. The provider has opted out of Medicare....
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1 - whether someone is employed or not is never the sole deciding factor on what is primary and what is secondary. Here is a chart to help you: http://www.medicareintera...page=script&slide_id=317...
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Also, the GZ modifier is not appropriate in this case. GZ means that the doctor expects a denial for MEDICAL NECESSITY, and failed to get an ABN signed. Medicare may pay on a GZ claim; if they do not,...
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And another... in an emergency or urgent situation, the patient is considered unable to enter into an opt-out contract, so Medicare WILL accept the claim. Read more at the link I gave you.
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As an opt out provider, the provider submitted notice to Medicare that he/she has absolutely nothing to do with Medicare for two years. The provider is mandated to sign a contract with the Medicare...
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Re: Medicare question
Thank you Sharon and Steve for your responses!I agree, it looks like we may be "up the creek" as far as Medicare goes. One last question: If the patient is employed, would that make BCBS primary?...
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Not necessarily you would never use that as a general rule. They are considered working elderly and private insurance would be primary others will have it arranged that even though they are working...
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Re: Medicare question
mamad wrote: Thank you Sharon and Steve for your responses!I agree, it looks like we may be "up the creek" as far as Medicare goes. One last question: If the patient is employed, would that make BCBS...
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sporty981 wrote: Not necessarily you would never use that as a general rule. They are considered working elderly and private insurance would be primary others will have it arranged that even though...
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Being old doesnt mean you cant work. I live in a 99.999% medicare population area. Many still work. Some work as greeters for Walmart and Walmart provides them with commercial insurance as a...
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I normally check with Medicare first when I call because I've had people working with under 20 employees and have their commercial as primary. I actually have one now which is why I commented and they...
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Karen, that's so strange, I've never heard of such a thing! I've had people not sign up for Medicare, but that's about it.
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I know that's why it took me a while to wrap my head around it. I called both Medicare and BCBS this patient pays the premium to make BCBS primary I'm not sure if she had to do anything with Medicare...
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