BC Advantage - 2023 Issue 9

Navigating Carrier Guidelines for Optimal Practice Reimbursement

When a Medicare patient has multiple sources of insurance coverage, Medicare will only pay for services after the primary payor has processed the claim and made their payment.  Medical office staff must always verify the patient's insurance coverage thoroughly-gathering all necessary information from the primary insurance, such as policy numbers, claim submission instructions, and any preauthorization requirements, etc.Working with patient claims when Medicare is the secondary payor can be a complex process, and everyone on the team should understand current guidelines and procedures for compliant billing and reimbursement. Medicare reviews and updates some guidelines annually, and providers...

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