Question

Instructions

1. Read the Case Study Medicare Medical Billing found on Chapter 12, page 347 of the textbook:
   
   Ramon has received a bill for his recent visit to the doctor’s office. He is confused because he has Medicare and American Association of Retired Persons (AARP) insurance and does not believe he should owe anything. He called AARP and was told that a bill for the visit had never been received. He had been told that all claims would come directly from Medicare. He then called Medicare and asked why the claim had not been sent to AARP. Medicare stated that the physician’s office had not listed AARP as a secondary insurance carrier on the claim. Ramon realized that he had not given the office his AARP card at his visit.
   
2. Afterwards, answer the questions below:
   • How could his physician’s office have prevented this problem?
   • What is it called when Medicare forwards a claim to the secondary insurance?
   • If this claim had fallen under the Medicare deductible, would the secondary insurance pick up the change?

Answer 1

1) The Physician's office can prevent this problem through having the workplace workforce update the client's records every time they have a visit. If the office staff requested Ramon if there are any modifications to his insurance or if his contact data needs any updating he would have remembered to provide his AARP card to them.

2) The insurance plan that pays 2nd is known as the secondary payer. ... The secondary payer solely pays if there are prices the foremost insurer did not cover. The Medicare Coordination of Benefits (COB) program wants to make positive Medicare can pay your claims right the first time, each time.

3) If the claim was Medicare permitted and you have met your deductible, then secondary has to choose it up. If iyou have now not met your deductible then it have to be utilized toward your deductible. Ifvtge claim was once now not Medicare permitted then the secondary possibly will no longer cover it. And it won’t observe towards your deductible.

I will make clear by using saying i am referring solely to Medicare supplemental (medigap) plans..