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Thread: Medicare and Secondary Insurance Billing Q

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    Medicare and Secondary Insurance Billing Q

    Hi all,

    I'm just about at my wits end trying to figure out a straight answer to this doozy:

    We have a patient in for an eye exam. We are NOT a medicare provider and do not do any medicare billing. We can however bill the patients secondary insurance since we have a contract with that particular insurance (supplemental insurance). What is the best way to go about this? Does the patient still self pay up front and submit to Medicare even though we can bill her secondary? I called the secondary insurance who told me we can send a claim to them directly but we must include a medicare opt-out letter. Can anyone tell me what that would entail? Either way we would be able to medically for the exam.

    Thanks!

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    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    You can still bill medicare as a non participating provider. However if you do not want to bill, and don't plan on billing ANY medicare for the next 2 years, then you will need to notify the medicare contractor for your area in writing, and have it with it the details outlining your agreement. You must then enter into private contracts with the beneficiaries, where you have them sign a letter stating they understand that not only do you NOT BILL for Medicare services, but Medicare WON'T PAY for said services either.

    Some helpful links: CMS Form
    Sample Letter
    Good FAQ on Par/NonPar/Opt Out
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    IDK about Washington, but in California Medicare does not cover for refraction, only medical exams such as glaucoma checks, diabetic checks and eye infection or injury. We charge a separate refraction fee. And then Medicare only covers glasses twice per lifetime, post-cataract surgery. For THAT our office isn't able to bill for Medicare as the Primary plan but we can bill for the post-ops for the Medicare as secondary.

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    Quote Originally Posted by Jubilee View Post
    You can still bill medicare as a non participating provider. However if you do not want to bill, and don't plan on billing ANY medicare for the next 2 years, then you will need to notify the medicare contractor for your area in writing, and have it with it the details outlining your agreement. You must then enter into private contracts with the beneficiaries, where you have them sign a letter stating they understand that not only do you NOT BILL for Medicare services, but Medicare WON'T PAY for said services either.

    Some helpful links: CMS Form
    Sample Letter
    Good FAQ on Par/NonPar/Opt Out
    This is very helpful, thank you so much! Maybe I'll just try and bill Medicare as a non participating, although they sure do take a while to process claims. Those links were great, thanks for sharing!

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