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Since Medicare has paid for all diab. and non-diab visits, I think Medicare should be refunded the money for all diabetes (but not non-diab) visits and I should NOT adjust according to priv. ins. on diabetese and according to Medicare on non-diab. claims????


Only if the private carrier has informed you that they are subrogating against the liability carrier. If they have no subrogation agreement, you bill the patient, because they got the settlement.

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OK, I was able to coverse the patient on the matter. This is not workers' comp per say, but a 'court settlement', in which the patient got diab. b/c of heart medication so all his diabetese claims need to go to this priv. ins. and all non-diab. claims go to Medicare.


This is raising some red flags for me. Even the average lay person has at least a basic understanding of the differences between worker's compensation and liability. Have you thought about looking into some classes so that you can have a better grasp of non-health-type insurance?

Or maybe I'm the dummy in assuming that "per say" really means "per se"?