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Medicare as a Secondary Payer and Consults

By: Codapedia Editor (Mon, Jan/10/2011)

Now that Medicare doesn't recognize consults (effective 1-1-10), how will we bill for patients who have a commercial insurance as primary, and Medicare as a secondary payer?  There are no great options.

Options for office “consults”

 Options for hospital “consults”

Looking for the source documentation?  Here's an excerpt the MedLearn Matters article:

Medicare will also no longer recognize the consultation codes for purposes of determining Medicare secondary payments (MSP). In MSP cases, physicians and others must bill an appropriate E/M code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes, physicians and others billing for these services may either:

o Bill the primary payer an E/M code that is appropriate for the service,

and then report the amount actually paid by the primary payer, along

with the same E/M code, to Medicare for determination of whether a payment is due; or

o Bill the primary payer using a consultation code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with an E/M code that is appropriate for the service, to Medicare for determination of whether a payment is due.

Note: The first option may be easier from a billing and claims processing

perspective. 

 

 

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