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Billing Medicare

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Beverly J. Pedroche

I'm new to (doing my own) billing and have a question when submitting to Medicare. On the CMS1500 form, on line 24f (Charges), do I input my charge/fee or the Medicare allowable rate? It appears the Simple Practice software automatically enters my (full) rates. Will Medicare simply pay the allowable?

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15 comments

Date Votes
  • Gillian

    Hi Beverly, I'd be happy to help with your question. When billing Medicare or any other insurance payer, you'll always want to input your full fee. The insurance payer will pay the allowable rate, and you'll be able to write off the different when you enter the insurance payment. Let me know if you have any additional questions about this, or anything else SimplePractice. I'm here to help. 

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  • Jamie Wilson

    I am not allowed to be credentialed with Medicare (my license is not accepted), so I do not have a PTAN.  My question is I have a client that has Medicare as primary and Medicaid as secondary (which I do take), how do I bill Medicare (and get denied) so that I can bill Medicaid as secondary?

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  • Erica Thomas

    How do I coordinate Medicare billing if they have another insurance, such as Tricare for Life.  Which one should I put as primary?

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  • Sue Nadel

    Where can I input my PTAN number so it is included on CMS 1500?

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  • Theodore Solomon

    I tried to billing Medicare on client through Simple Practice and was told I had to enroll for this.  What do I need to do to qualify to to this.  I am a Medicare provider and have PTAN #.  I previously have even successful billing my Medicare ps on another EDI, Office Ally

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  • Theodore Solomon

    I want to be able to bill Medicare patients on Simple Practice 1500 form.  How can I be able to do this. How do I apply and get answer for this?

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  • Theodore Solomon

    Medicare

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  • Theodore Solomon

    Help answer question on billing Medicare

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  • Erica Thomas

    Hi Theodore, I've had to set up my billing Medicare through SP recently.  I went to "Settings" and then to the Insurance section and went the Medicare payer, according to your state.  For me being in Texas I went to Medicare Part B of Texas.  Then you click on "enroll" for "Claim filing enrollment" (to file claims electronically and also enrolled for the "Payer Form Enrollment" to ensure you get the EOB upon payment/processing of the claim.  When you enroll, you will also be prompted to give your PTAN. Just FYI:  It took about a month or so for these enrollments to go through.  So you can file claims through mail in the meantime or create a claim for all DOS's once your enrollment has gone through.  I hope that this helps!     

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  • Erica Thomas

    Oh PS:  There is no place on the CMS 1500 to put in your PTAN.  They will connect your NPI with your PTAN on their end.  

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  • Rose Porter

    Having an issue with Medicare claims being denied as group practice missing, incomplete, or invalid on claim.  

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  • Theodore Solomon

    I might try this again. I ran into a problem trying to enroll and had planned to contact Medicare EDI for guidance. In the mean time I continue to bill my Medicare clients on my other EDI, Office Ally, and my claims have been getting processed.

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  • Ruth

    Hi Rose, I'd recommend checking to see what information you're credentialed under with the insurance payer directly. Then your Settings > Insurance > Enrollments to see if you're enrolled under your Group Practice NPI, Tax ID and Billing information. Make sure your enrollment information matches the information you were credentialled with. If the two are different, or the Billing information on your claim doesn't reflect both, this could explain why your claims are getting denied. For more insight, you can submit an email Help Request to our Insurance Team. 

    Theodore, I'd recommend going to your Settings > Insurance > Enrollments page and clicking on the +Enroll button to enroll for each payer you bill. You can enroll for electronic claims filing and receiving ERAs through SimplePractice. If you've already done this, but ran into issues, I'd also recommend reaching out to our Insurance Team by submitting a Help Request.

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  • Kathryn Vaughn

    Has any one successfully billed Medicare with SP ?

    it seems that this is an issue for many users and has been for me. I end up getting frustrated and set it aside because I'm very busy . Paying for a separate biller for too long which is time consuming. I'm wondering if I need to look at other options? there really needs to be clearer support for this issue which has been an issue for years.

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  • Imme Staeffler

    I am planning on using SP for Medicare billing, Medicare Advantage plans and secondary insurances, how reliable is SP for these tasks. How user friendly is SP with regards to submitting claims and getting EOBs. Thank you.

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