As primary paid nothing and now patient is responsible to pay the balance but here is a catch that patient is eligible for MCD on DOS as a secondary payer, now whatever MCD paid on that claim, post payment in system and then whatever balance on account that need to adjust. If MCD pay nothing but chances not denied with code CO-23 as primary paid nothing on claim and we can apple but if denied with co-23 then we cannot bill patient the unpaid balance instead to adjust it off as per MCD as secondary insurance policy
In this case primary allowed 100% and processed towards patient responsibility and secondary allowed 50% so in this case we don't need to write off because no remaining balance left so we will bill to the patient
If the secondary payer is Medicaid we should not bill under patient responsibility? we can adjust or write-off under provider? But if the secondary payer is commercial we can bill pt? Is it correct protocol?
I some cases secondary Medicaid denied the claim for primary paid more than secondary allow, and Medicaid not made any payments they denied the whole claim, what can we do? Adjust the primary extra allowed only or whole claim.
@@dminmb not true. you have a contractual obligation with the primary payor to collect all copay/co insurance and deductible from the patient. if they have a secondary commercial insurance that does not cover the remaining amount for any reason, you are not only allowed, but obligated to collect that amount from the patient or you will be in breach of contract with the primary payor. the only exception to this is when medicaid is secondary.
@thusarawickramage6023 you bill the patient. If you don't and the primary insurance finds out, such as during an audit, you are telling them you are willing to accept less than the contractual rate and they will adjust their claims accordingly. If primary allows $100, pays $80 and puts $20 out to patient. If you don't collect that $20 either from the patient or from a secondary, the primary can assume you are willing to accept $80, readjust the claim, pay $60 and put $20 out to the patient. A few claims as a courtesy adjustment no one cares but a few thousand over several years and an auditor will eat your lunch.
Every insurance allows specific amount for every cpt and they pay accordingly. If primary allowed more than secondary will not pay. For example: if we have billed amount $500. Primary ins allowed and paid $400 for that particular cpt. Now secondary allowed amount is 300. Here primary already paid the amount which was allowed by secondary. So, then deny it stating primary already paid more.
As per my knowledge we can bill patient responsibilities (Deductible/copay/coinsurance) to secondary insurance, so if primary processed all allowed amount towards patient responsibility so why can't we bill to secondary as medicaid or any commercial insurance?
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Need to write off the remaining balance as patient has Medicaid as secondary.
Why write off? could you please explain it?
@@englishwithmks3439 by write off he meant adjustment.... Not the denial wo
As primary paid nothing and now patient is responsible to pay the balance but here is a catch that patient is eligible for MCD on DOS as a secondary payer, now whatever MCD paid on that claim, post payment in system and then whatever balance on account that need to adjust. If MCD pay nothing but chances not denied with code CO-23 as primary paid nothing on claim and we can apple but if denied with co-23 then we cannot bill patient the unpaid balance instead to adjust it off as per MCD as secondary insurance policy
we can't bill Medicaid pt
I love your vidoes! They are so helpful with freshers! Thank you!
In Medicaid there is no patient responsibility we need to adjust the amt.
oh I didn't know this
In this case primary allowed 100% and processed towards patient responsibility and secondary allowed 50% so in this case we don't need to write off because no remaining balance left so we will bill to the patient
My ans is allowed amount of 50% will be billed to patient. Because primary processed as out of pocket.
Waiting for the denials video,bro
We can not bill to the patknrr when he has medicaid
We do write off the balance
Please explain provider not certified denial...kind request....
Hi bro can you make a video on important modifiers. Thank you
sure bro. Welcome :)
Please make it soon bro...
If the secondary payer is Medicaid we should not bill under patient responsibility? we can adjust or write-off under provider? But if the secondary payer is commercial we can bill pt? Is it correct protocol?
If the patient has this Medicaid SLMBQ plan then we will billed to patient for the due amount.
Need to write off as primary paid amount more than the allowed amount
Sir can u explain appeal process?
Please make video on all 25 denials
Can you please provide me list of all those denials
I some cases secondary Medicaid denied the claim for primary paid more than secondary allow, and Medicaid not made any payments they denied the whole claim, what can we do? Adjust the primary extra allowed only or whole claim.
Bill to the patient
Need to provider write off
Bill to patient
Adjust clim
Kindly provide the deniel code for each deniel you explain
Sure bro
OA 23 for this one.
Can u pls explian duplicate denial
Babu ji006 easy one
Yah
Bro music is too louder can u please make it bit lower r not needed
Background music is to loud
If secondary payer is Medicaid we use to adjust it, if it is commercial payers then we move the balance to the patient is this correct protocol?
Even in case if secondary commercial payor... if Secondary allowed amount is less than primary allowed amount.. we need to adjust the balance
@@dminmb not true. you have a contractual obligation with the primary payor to collect all copay/co insurance and deductible from the patient. if they have a secondary commercial insurance that does not cover the remaining amount for any reason, you are not only allowed, but obligated to collect that amount from the patient or you will be in breach of contract with the primary payor. the only exception to this is when medicaid is secondary.
Is it? Thank you for this update @L T
@@LWT80 so what's the action ? Adjusting off or billed to patient
@thusarawickramage6023 you bill the patient. If you don't and the primary insurance finds out, such as during an audit, you are telling them you are willing to accept less than the contractual rate and they will adjust their claims accordingly. If primary allows $100, pays $80 and puts $20 out to patient. If you don't collect that $20 either from the patient or from a secondary, the primary can assume you are willing to accept $80, readjust the claim, pay $60 and put $20 out to the patient. A few claims as a courtesy adjustment no one cares but a few thousand over several years and an auditor will eat your lunch.
Waiting for new video
I'll upload it soon
Why secondary denies in case primary pays more than secondary allowed amount?
Every insurance allows specific amount for every cpt and they pay accordingly. If primary allowed more than secondary will not pay. For example: if we have billed amount $500. Primary ins allowed and paid $400 for that particular cpt. Now secondary allowed amount is 300. Here primary already paid the amount which was allowed by secondary. So, then deny it stating primary already paid more.
@@dminmb why do primary pay more in general cases?
Because they are high premium policies than secondary
@@dminmb why does'nt secondary pay the remaining amount? Wouldn't it be a loss to the provider?
No bro, if secondary allowed amt is less. They'll pay accordingly. Simple
need to bill patient for 50% another 50% write off
Its wrong
We shouldnt bill to patient, since the secondary is medicaid..
As per my knowledge we can bill patient responsibilities (Deductible/copay/coinsurance) to secondary insurance, so if primary processed all allowed amount towards patient responsibility so why can't we bill to secondary as medicaid or any commercial insurance?
The Background music is horrible and made me immediately stop the video