Newbie Medicare Billing question


(Sherwin Gaddis) #1

@stephenwaite @visolveemr

We are new to billing with the system and Medicare.
We noticed that when having Medicare as the primary insurance the system shows that balance to be owed by the patient and not the insurance company.

What are the rules for Medicare being the primary insurance company?

openmedpractice . com


For the most part if the patient is eligible for Medicare, the only time Medicare is not the primary insurance is when the patient is still working full time with employer provided insurance. When you put in both primary and secondary insurance information and send electronic X12 billing Medicare will usually automatically send the secondary billing and will mark the EOB you get back as forwarded. If that does not happen, when you put in the Medicare payment you check the secondary billing box and go back and make a new X12 file to send.

(Sherwin Gaddis) #3

What we found is that the system process information differently between the old post system and the new batch payment system. When we used the new batch payment system to post a cash payment made by the patient. The balance showed due insurance like it was expected to be.