In certain circumstances, Medicare beneficiaries may be covered by other insurance. In many situations, Medicare is the secondary insurance rather than primary. Additionally, as Medicare beneficiaries continue to remain employed, there will be increasingly more cases of people over 65 years of age that use Medicare as secondary coverage.
To help physical therapists determine if Medicare is a patient's primary payer and bill accordingly, APTA has posted an FAQ that offers information on verifying Medicare's primary/secondary status, using Medicare documentation standards when Medicare is secondary, submitting claims with the KX modifier, and more. The new resource also addresses the process for submitting claims to Medicare that have been denied by the primary payer.