Forum - Questions & Answers

Apr 7th, 2016 - dgirardi 1 

billing with two insurances

If a patient's primary insurance has a contracted rate for certain procedures (ie. office visit -99214 and refraction- 92015) and there is a secondary insurance that gets billed(in this case- by the patient) for overlapping procedures, do I refund the full amount to the secondary insurance for the overlapped procedures or can I collect payment for the difference of what the primary insurance paid?

Apr 7th, 2016 - LBAROGIANIS 250 

re: billing with two insurances

This depends on your contracts.

Ex. 1 Medicare Allows CPT® 99214 $100.00

Secondary: Amerigroup - Your contract states 120.00 for CPT® 99214.

If Medicare pays 80%, which is $80.00, then your secondary should pay up to your contracted rate.

Which is $120.00, so Amerigroup would owe you $40.00.

Ex: 2 Medicare allows CPT® 99214 $100.00

Secondary: Medicaid, they allow for CPT® 99214 50.00

Medicare pays 80%, which is $80.00, Medicaid does not pay anything because Medicare paid more

than Medicaid's allowable.

Hope this helps!!

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