tci Medicare Compliance & Reimbursement - 2010 Issue 24

Reader Questions: Resolve Secondary Payer Issues With Conversations

Question: Our doctor performed surgery on a patient 11 months ago. We just learned that the patient had primary and secondary insurance at the time. The payer she said was secondary was really primary. The secondary insurance company paid us as primary, however. Are we obligated to refund the money even though it's been almost a year?Answer: Since you find out about the error -- for example, if the patient called your office several months later and explained the situation -- you should call the payer and let it know of the error. Then, leave it up to...

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