Certified Medical Assistant (CMA AAMA)Administrative: Billing, Coding and SchedulingMedium
A medical assistant is preparing a claim for a patient who has Medicare as her primary insurance and a Medigap policy as her secondary. After Medicare has processed the claim, what is the next step for submitting the remaining balance to the Medigap policy?
- AMedicare automatically forwards the claim information to the Medigap insurer if listed.
- BWait for the patient to manually submit the Medicare EOB to Medigap.
- CSend a new CMS-1500 directly to the Medigap insurer.
- DForward the Explanation of Benefits (EOB) from Medicare to the Medigap insurer.
Show answer & explanationAnswer & explanation
Correct answer: A. Medicare automatically forwards the claim information to the Medigap insurer if listed.
For patients with Medicare and a Medigap policy, Medicare generally automatically forwards the claim information, including the EOB details, to the Medigap insurer once the primary claim is processed. This is known as crossover.
Why the other options are wrong
- B. While patients can do this, it's not the standard or most efficient process when crossover is available.
- C. Sending a new CMS-1500 is typically not needed for Medigap as Medicare handles the crossover.
- D. This might be required if automatic crossover fails, but it's not the primary or expected next step.
Medicare Crossover Claims
The automatic transmission of Medicare claims data to a secondary payer (e.g., Medigap) after Medicare has processed the primary claim.
- Applies to patients with Medicare and a secondary plan.
- Eliminates the need for providers/patients to submit claims twice.
- Requires the secondary payer to be on file with Medicare.
Memory trick: Crossover: Medicare 'crosses over' the info to Medigap.