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As mentioned yesterday, verification of benefits (V.O.B) is the 1st step in the billing process and it will affect your bottom line.

Tips and Ideas
Tips and Ideas

Today’s tip/trend is related to Medicare beneficiaries and their secondary coverage.  Many practices incorrectly assume that if a patient has a secondary plan to Medicare, that the Medicare deductibles and coinsurance portions will automatically be picked up by the secondary.

This is not always the case. If the plan is a Medicare supplement it will normally pick up the coinsurance (and usually, but not always the deductible) but will not cover any services that Medicare denies. AARP and some others offers this type of plan.

A plan that is secondary to Medicare, what we call a true secondary, is often an employer group plan and will many times have a deductible of its own to be satisfied and possibly even it’s own coinsurance or co-pay. However, these types of plans will frequently cover services that Medicare considers non-covered, or if the patient has maxed out his/her therapy benefit.

Recent trend: We have recently noticed that some of the Medicare secondary plans offered by some carriers are not reimbursing anything at all.  Their explanation of benefits statement will usually state something along these lines: “If Medicare pays less than this plan’s benefit, we will consider the difference. The plan’s allowable benefits are based on the Medicare approved amount.”


Translation: (after numerous phone calls to the carriers) “If Medicare allows the same or more than the plan would have allowed if it were primary, then there is no reimbursement. The balance is the patient responsibility.”

Whoa! Now do you think you will have some unhappy patients when they receive your bill in the mail?  You can bet on it!

A thorough verification of benefits for the patient’s secondary coverage can eliminate any billing surprises down the road for your patients. But remember: when verifying secondary plans, the CSR rarely reveals the above limitation unless you specifically ask. Be sure to ask, Is there a non-duplication provision?”


So do your homework and share the information with your patients so that all concerned know what to expect. No surprises and everyone is happier in the end!

No Surprises = Happy Patient!
No Surprises = Happy Patient!