Question

A patient has Medicare as their primary insurance and Medicaid as their secondary insurance. Medicare pays $125 on a service and lists $25 as patient coinsurance. They've automatically forwarded the remittance to Medicaid, yet Medicaid hasn't paid. When you inquire about Medicaid's payment, they inform you that they allow only $100 for that service. What do you do?

Answer 1

In this situation, you would need to contact Medicare and Medicaid to discuss payment discrepancies. In addition, you may need to submit an appeal to Medicare to get the total amount of the service covered.

Step-by-step explanation: