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PATIENT COPAYMENT AND DEDUCTIBLE BILLINGS AND SECONDARY CARRIER BILLINGS

If Medicare Part B is your patients primary insurance carrier and the patient has one of the select secondary payers that reciprocates with Medicare, then the secondary carrier will be informed that they owe you a payment for their patients covered charges.

Medicare forwards to those select carriers electronically and the secondary carrier ( also called the Medigap carrier ) remits directly to you.

However some secondary carriers do not reciprocate with Medicare. In those cases a copy of the EOMB showing the Medicare approved amount and the payment you received from Medicare, and a separate invoice for the patient copay or deductible amount must be generated and sent directly to the secondary carrier to receive the copayment or deductible money from the secondary carrier. Integrated will produce that billing for you and forward it to the Medigap payer.

For most providers, we download the electronic remittance advice ( also called the E.O.M. B. ) and process your receivable. For their primary carriers and almost all Medigap payers, you will receive the check and EOMB. You must send Integrated ( by fax or by mail ) all remittance advises you receive for any claim we generate for you. Integrated uses the EOMB's to purge the accounts receivable ( A / R ), review if you received the correct payment, resubmit claims as necessary, and generate secondary insurance claims as required. This is why you must send all remittance advises to Integrated.

In some cases, if the patient has Medicaid as their secondary carrier, you may not receive any additional money even thought you only receive eighty percent ( 80 % ) from Medicare. This happens often when the Medicare payment is equal to or greater than what Medicaid would have paid for the patient's products. In most cases, you cannot bill the patient.

When there is no secondary carrier to bill for copayments or deductibles, then the patient is responsible for the twenty percent ( 20 % ) or their annual deductible. Also, with many Private Insurance Carriers ( Blue Shield, F.E.P., others ) the patient is responsible for a portion of all charges submitted. When you forward to Integrated your EOMB we generate a MONTHLY PATIENT CHARGES SUMMARY that identifies any monies due you from your patients. You should use the report to generate your own invoice to the patient for those charges.

Optionally, Integrated will generate an invoice and forward that invoice directly to your patient. There is a small additional fee for this service. For information about this option, please contact Integrated for more information.

However, using the MONTHLY PATIENT CHARGES SUMMARY simplifies billing your patients for monies they owe you from your office. For help billing your patients yourself, please contact Integrated for more information.