tci Medicare Compliance & Reimbursement - 2017 Issue 13

Reader Question: Can You Bill Medicare Even If You Aren't Enrolled?

Understand the out-of-network payment option. Question: Our orthopedic practice sees primarily pediatric patients at a children’s hospital, and therefore we are not enrolled with Medicare. However, we have one patient who we thought only had Medicaid, but it turns out has Medicare as well. Since we aren’t enrolled with Medicare, we cannot bill Medicare to get a denial, and Medicaid will not process the claim without the Medicare denial. Can you help? Supercoder.com Subscriber Answer: You absolutely can file the claim with Medicare, but you’ll be paid as an out-of-network provider, so just like with...

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