When is Medicare Primary or Secondary
There remains much confusion how to bill for outpatient therapy services when an outpatient therapy patient is entitled to Medicare, but may also be covered by a group health plan (GHP) or a non-group health plan (NGHP), such as workers compensation or auto no-fault, being primary. In this article, I will answer the following questions:
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In an example case that you are billing a motor vehicle or WC payer as primary but they deny the claim, when then attempting to bill Medicare (with the denial reason), would you need to change the billing rationale from substantial portion billing methodology to Medicare’s 8-minute rule methodology?
If expecting Medicare to pay, then you would need to follow Medicare’s outpatient documentation and billing rules.
If a patient has BCBS Medicare Plan Highmark, is this treated as Medicare or more as BCBS documentation? More specifically does this pt need a signed POC?
thanks
Thomas K PT
Please read my Medicare Advantage FAQs at https://gawendaseminars.com/faq/medicare-advantage-plans/