tci ED Coding & Reimbursement Alert - 2019 Issue 1

Reader Question: Will Medicare Pay for Non-Covered Workers' Comp Visits?

Question: Thank you for your Q&A last month about workers’ compensation coding. I have a follow-up question. When the patient has workers compensation and Medicare, and workers’ comp doesn’t cover the whole visit, can we bill Medicare for the balance? Supercoder Subscriber Answer: Yes you can. The workers’ compensation insurer will always be the primary payer, but “If workers’ compensation insurance denies payment, and you give Medicare proof that the claim was denied, Medicare will pay for Medicare-covered items and services as appropriate,” CMS says in its “Medicare and Other Health Benefits: Who Pays...

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