Auto Accident and Billing Medicare

January 21, 2019
Rick Gawenda

I recently had a question submitted to me by one of my Gold Members. Here is the situation and question.

We had a patient who had an auto insurance that was in litigation that settled; however, we did not even get 50 percent of what we charged. Are we allowed to bill the secondary for the remainder for payment? The secondary insurance is Medicare.

Here is information I found that may assist you in the future if you encounter this situation. According to the Centers for Medicare and Medicaid Services,

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  1. Hi Rick, very helpful article. The scenario we get most often when verifying benefits for Medicare is an old MSP code stating there was, at some point another liability (MVA/WC). When we bring this up to the patient, sometimes they aren’t even aware of it, or they state that it was something old and closed. In that case, is this because the patient never contacted the BCRC to close out the case? If the patient fails to contact the BCRC to state that the other liability case has been closed, could that result in a denial from Medicare if they think the current episode of care is linked to the previous liability case? Should an ABN be used since the treatment is medically necessary and there is a possibility that Medicare will not pay? We would really like to know the correct procedure to follow for this as it does happen quite frequently.

    1. I am not sure that there is an “always correct procedure”. I would recommend you contact your Medicare Administrative Contractor when this situation occurs.

  2. This was an interesting and timely post. We ran into this issue on a current client. The patient was being seen for PT for chronic pain thoracolumbar and B shoulders. R shoulder is scheduled for TSA. In the process of treating this client, they were rear ended and precipitated a cervical strain on top on all her other issues. We set the patient up with a separate episode of care from her existing medicare account. We identified the auto carrier as her only pay source on this second EOC. We just received a letter from the auto carrier stating that Medicare had place a lien on any of our payments and requesting a refund of a small existing payment. Why is MC placing a lean and why haven’t we heard anything from MC regarding this claim and the confusion. Would love some input.