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Medicare Billing

The Challenge

Medicare does not cover services by Naturopathic Physicians.

Medicare does not even recognize Naturopaths, precluding our clinic from even attempting to bill on the behalf of patients. Even worse, this stance prevents Naturopaths from being able to order labs for Medicare patients. This is true even if the patient wanted to pay for labs out of pocket*.

That makes things a bit more difficult for patients on Medicare who want quality alternative care.

The Solution

Fortunately, we can and do see Medicare patients at Specialty Natural Medicine.  All services, procedures and supplements are provided on a "cash" basis.  This simply means that the patients pay for their services and items at check out (cash, check or credit card).

We have had great success working with Medicare patients primary provider to coordinate care.  This includes having the primary care provider forward lab results to our clinic to be used by our physicians in developing treatment plans for patients.

* - For labs that bill Medicare. Labs that do not have any contractual relationship with Medicare may opt to receive cash payments for lab services. This is very rare.

Secondary Insurance and Medicare

Some Medicare patients have Medicare as their primary, but also have secondary insurance that covers Naturopathic Doctors.

We can bill secondary insurance on the patient's behalf, but cannot bill Medicare directly at all.

The workaround recommended by Noridian (Medicare processor) is for patients to submit a bill to Medicare and generate a denial letter.

From Noridian Medicares website:

Question:  How does a provider request a Denial Only letter?

Answer. Providers who are eligible to enroll in Medicare must do so if they provide covered services to a Medicare beneficiary. Under the Mandatory Claim Submission rule, it is a requirement that providers and suppliers submit Medicare claims for all covered services on behalf of Medicare beneficiaries.

For providers who cannot enroll in Medicare, such as naturopathic physician, or for services that are non-covered, a 1490S form must be submitted. The 1490S, is a form that must be completed and submitted by the beneficiary. To check the status of the form, the patient must contact the Beneficiary Call Center and they will also receive the Medicare Summary Notice which can be used to submit to a supplemental insurance.

 

As noted above we cannot bill directly or check on claim status on the patients behalf.

For Medicare patients with secondary insurance, we ask them to pay for services up front, submit their Medicare bill and provide us with the denial letter.  Once we receive the denial letter, we can bill their secondary insurance on their behalf.  When we receive the payment and explanation of benefits from the patients secondary insurance, we refund any overpayment from the initial date of service.

Secondary Insurance Process and Timeline

  • Patient sees the physician at an office visit and pays the complete cash rate for all services and items.
  • Patient submits form 1490S to Medicare for processing.  Specialty Natural Medicine can assist with filling out the form.
  • Patient is responsible for forwarding denial letter to Specialty Natural Medicine.  As we cannot contact Medicare on the patient's behalf, it is solely the responsibility of the patient to contact Medicare to determine status of claim.
  • Once Specialty Natural Medicine receives the denial letter from the patient, we bill the secondary insurance on the patients behalf.
  • Once payment and Explanation of Benefits is received from secondary, Specialty Natural Medicine will refund any over payment for billed services (generally limited to office visits and medical procedures).
  • Refund is subject to deductions per secondary insurance explanation of benefits, including co-pays, co-insurance or deductibles that generate patient liability.

Please note that insurance companies have "timely filing limits".  This means they need to receive a claim within a certain time after the date of service.  Although this generally is extended for secondary insurance as the primary is processed, there is the potential for secondary insurance to deny coverage due to missing the timely filing limits.  Claims denied by secondary for timely filing limit issues will result in the patient being liable for the visit and procedures.

Please note that we cannot submit labs for patients with Medicare, even if they have secondary insurance that covers Naturopathic Doctors.