Example<\/strong><\/h4>\n\n\n\nLet\u2019s consider a real-world example.<\/strong><\/p>\n\n\n\n\nA healthcare provider performs an appendectomy on a senior patient and bills Medicare for $8,350.<\/li>\n\n\n\n Medicare processes the claim and pays $6,250 according to the patient\u2019s plan.<\/li>\n\n\n\n After paying its portion, Medicare sends the processed claim to the patient\u2019s secondary payer, Medicaid, in this case.<\/li>\n\n\n\n Medicaid receives the crossover claim and then covers the remaining amount. In the end, the patient owes nothing to the healthcare provider.<\/li>\n<\/ul>\n\n\n\nHow to Bill <\/strong>Medicare Crossover Claims<\/strong>?<\/strong><\/h2>\n\n\n\nIf your patient has another insurance plan besides Medicare, you only need to file the first claim. Medicare will do the rest for you. You can follow these simple steps to file the initial Medicare claim.<\/p>\n\n\n\n
Verify Patient\u2019s Dual Insurance Eligibility<\/strong><\/h3>\n\n\n\nCheck if your patient is eligible for a supplemental insurance benefit besides Medicare. Go through their insurance plan and make sure that the information is up to date.<\/p>\n\n\n\n
Obtain Pre-Authorization<\/strong><\/h3>\n\n\n\nMedicare only covers some treatments or services if they are medically necessary. Therefore, identify such procedures and obtain prior approval to avoid claim denials.<\/p>\n\n\n\n
Code the Diagnoses and Treatments<\/strong><\/h3>\n\n\n\nAccurate coding is the key to quick reimbursements from Medicare. Make sure to use the latest and valid diagnosis (ICD-10) and procedure codes (CPT or HCPCS) when filing medical claims. <\/p>\n\n\n\n
Submit the Medical Claim to Medicare<\/strong><\/h3>\n\n\n\nThe next step is to submit the medical claim to Medicare. Gather all the supporting documents and include correct information about the patient, including ID number, name, and address. Don’t forget to provide all the details about the secondary payer, including the beneficiary ID, so the claim can cross over automatically.<\/p>\n\n\n\n
You have two options to submit the claim. You can either submit it electronically via the Medicare Administrative Contractor (MAC) or manually. Individual healthcare providers, like doctors and therapists, can use the CMS-1500 claim form to file manual claims. However, if you work in a hospital, nursing home, or rehabilitation center, use the UB-04 to submit the claim.<\/p>\n\n\n\n
What’s Next?<\/strong><\/h3>\n\n\n\nAfter this, Medicare will process the claim and automatically send your claim to the secondary payer. However, BCRC will reject the crossover claim if there is any error. In that case, you must file the secondary claim manually with a copy of the Remittance Advice (RA) – a document sent by Medicare.<\/p>\n\n\n\n
Billing Challenges with Crossover Claims<\/strong><\/h2>\n\n\n\nThe crossover claim simplifies the entire billing process. However, the process of crossing over itself is quite complex. Here are some common challenges:<\/p>\n\n\n\n
Incorrect or Missing Secondary Payer Information<\/strong><\/h3>\n\n\n\nA lot of the time, the main culprit for issues is incorrect or missing information about the secondary payer. If the beneficiary ID or payer information is missing from the initial claim, BCRC cannot route it to the correct secondary insurer.<\/p>\n\n\n\n
To prevent this, you must always check whether the patient has more than one insurance payer. If yes, then ensure to get the details for all of them before providing any services.<\/p>\n\n\n\n
Claim Rejections Due to Coding Errors<\/strong><\/h3>\n\n\n\nBCRC will reject a crossover claim if it contains incorrect diagnosis or procedure codes. Even a minor coding mistake can delay your reimbursement significantly.<\/p>\n\n\n\n
So, make sure that there are no billing and coding-related mistakes in the claims. <\/p>\n\n\n\n
Delayed or Missing Crossover Transmissions<\/strong><\/h3>\n\n\n\nNot every claim crosses over automatically. If you don’t see RARC code MA18 or N89 on your Remittance Advice, Medicare may not have transmitted the claim.<\/p>\n\n\n\n
In that case, you must file the secondary claim manually with a copy of the RA.<\/p>\n\n\n\n
Auto vs. Manual Crossover Claims<\/strong><\/h2>\n\n\n\nThe crossover claims are processed in one of two ways: automatically or manually. Here’s how they are different:<\/p>\n\n\n\n<\/th> Auto Crossover<\/strong><\/th>Manual Crossover<\/strong><\/th><\/tr><\/thead>How it works<\/td> Medicare automatically transmits the claim to the secondary payer via BCRC<\/td> Provider submits the secondary claim directly with a copy of the RA<\/td><\/tr> When it happens<\/td> Secondary payer has a COBA agreement with CMS<\/td> No COBA agreement exists, or the auto crossover fails<\/td><\/tr> Provider effort<\/td> Minimal, file one claim and Medicare handles the rest<\/td> Higher, additional documentation and submission<\/td><\/tr> Risk of errors<\/td> Lower, as transmission is system-driven<\/td> Higher, as manual entry increases the chance of mistakes<\/td><\/tr> Turnaround time<\/td> Faster<\/td> Slower<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\nBottom Line<\/strong><\/h2>\n\n\n\nMedicare crossover claims save healthcare providers from additional work. To summarize, Medicare covers a significant part of its beneficiaries\u2019 treatment. It then automatically crosses over the processed claim to their secondary payer (Medicare and any other private insurance offering supplemental Medicare benefits).<\/p>\n\n\n\n
You should submit accurate medical claims with the latest codes to Medicare for a successful crossover. Otherwise, you\u2019ll have to allocate extra time and resources to file secondary claims. Therefore, it is better to outsource medical billing services<\/strong><\/a> to avoid such situations.<\/p>\n\n\n\nFREQUENTLY ASKED QUESTIONS<\/strong><\/p>\n\n\n