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?
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!!