Monitoring FAQs

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  1. Do I have to submit claims for patients that have Medicare as a secondary insurance?
  2. How do I know that a patient has Medicare?
  3. Can a beneficiary submit a claim for denial when their doctor has opted out of Medicare?
  1. Do I have to submit claims for patients that have Medicare as a secondary insurance?

    Yes, if you have a copy of the Explanation of Benefits (EOB) from the beneficiary's primary insurance, then you are required to submit a secondary claim to Medicare. If you did not receive an EOB directly from the primary insurance, but the beneficiary provides you with a copy of the one they received, you are required to submit a claim to Medicare.

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  3. How do I know that a patient has Medicare?

    You should ask your patients each time they come to the office. We suggest that you place a statement on forms that the patients fill out, "Do you have Medicare? ___Yes ____No." This statement helps to cover your liability.

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  5. Can a beneficiary submit a claim for denial when their doctor has opted out of Medicare?

    No, this can create a violation of the opt-out agreement for the provider.

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Page Last Updated: Wednesday, 14-Dec-2011 16:46:34 CST