Medicare as a Secondary Payer and Consults

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”

• Bill primary with consult codes.  Will cross electronically to Medicare, and be denied.  Resubmit electronically, with a note in other information field about primary payment.  Requires handling of every claim.  If primary allowance is more than Medicare, and small secondary Medicare balance, may be okay.
• Bill primary with new or established patient visit code, will cross electronically to Medicare and be paid automatically.  Less revenue.  No extra handling of claim.

 Options for hospital “consults”

• Bill primary with consult codes. Will cross electronically to Medicare, and be denied.  Resubmit electronically, with a note in other information field about primary payment.  May be best bet for hospital services.
• Bill primary with initial hospital services codes.  How will they process multiple initial hospital services codes from different physicians?

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.