Monday, October 5, 2009

Medicare Billing Question

Posted by Mark Maughan

What steps do you advise clients to take when a hospital refuses to bill Medicare claiming that they must first bill and receive a denial from the liability carrier? We are involved in a case with a trucking company that is disputing liability, and I know that their insurer will not send a written denial letter that the hospital wants before billing Medicare. Can we submit the bill to Medicare directly? Is there a procedure for that? Obviously it would be a conditional payment by Medicare if they pay the bill, but getting there is getting harder and harder.

Thanks for any advice,
Ohio Attorney

When a service provider learns that a beneficiary received services that may be payable by another payer primary to Medicare, the provider is required to pursue payment from that primary payer for a period of 120 days following the date of treatment. At the end of the 120 day period, if the insurer has not made payment, the provider may choose to bill Medicare conditionally or to continue to wait for payment from a future insurance settlement. If the provider chooses to bill Medicare, then it becomes the Medicare Secondary Payer Recovery Contractor’s responsibility to recover Medicare’s payment if a settlement occurs at some point in the future. The provider is not required to send the bill to Medicare if they choose to pursue payment from a possible future insurance settlement.

Has it been 120 days since the last date of service? If it hasn’t, you will have to wait for 120 days to pass, and then the hospital can bill Medicare. If the 120 days has passed, and the provider still won’t bill Medicare they may be unaware of the procedure. It may help to speak with them and educate them on the process. You would be surprised of the number of facilities and providers that don’t realize they can bill Medicare without a denial from the primary payer.

To answer your question regarding direct Medicare billing, yes, you can send in a claim requesting Medicare make payment to your client. If you’d like information regarding this process, let me know and I will have our Manager of Medicare Services, Mary Skinner reach out.

I hope the above is helpful.

My best,
Mark H. Maughan