Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Council on Medical Economics Subcommittee on Computer Application. July 10, 1985

10:00 a.m. I. CALL TO ORDER

II. MEDICARE-MEDICAID CROSS OVER BILLING

A. Influence of HCFA Regulations

B. Dr.Fisher's Letter to HCFA

C. HCFA Response to Dr. Fisher

III. PENNSYLVANIA HEALTH DATA COUNCIL

A. Dr. Heisterkamp Correspondence to Dr. Fisher

B. HB 1582

IV. MEDICARE PREVAILING CHARGES (LEVEL II) 1984- PENNSYLVANIA

V. ADJOURNMENT

Influence of HCFA Regulations on Cross-Over Billing

Definition: Cross-over billing is a process by which a provider bills the primary insurance carrier, and the primary carrier then sends an electronic notification to the secondary insurance carrier. This process reduces duplicate billing, prevents errors, reduces key-entry costs, speeds the claims flow, and produces administrative savings to both insurance carriers as well as to the provider. All parties are consequently anxious to promote cross-over billing.

Problem: In the case of cross-over billing between Medicare and Medicaid, a problem is created when the provider number for group providers or assignment accounts is used since these provider number usually differ from those of the individual provider himself. HCFA rules permit Medicare to utilize group and assignment-account provider numbers, but HCFA insists that Medicaid utilize only individual provider numbers.

Proposal: That HCFA reconciles the rules for the two programs so that a uniform system is employed. The Pennsylvania Medical Society has no position as to position as to which system is superior and limits its petition to the creation of uniform rules for provider numbers.

Originally published: Thursday, December 13, 2018; most-recently modified: Wednesday, May 15, 2019

 

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