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Self-Referrals for Medicare Part B

MacPractice has an option that allows you to automatically place a self-referral on all Medicare Part B claims when no other referral is used. This document will assist you in using and configuring this option.

Self-Referral Set-Up
Sometimes Medicare requires a referral to be placed on a claim in box 17 even if the patient was not referred to the office. In these cases, the patient's provider can be used as the referring provider instead.

Your provider needs to be entered as a Referrer in References if they are not already.

Go to the References ability and select Referrers in the sidebar. Click the plus button to create a new reference and enter your provider's information. Make sure the Is Person and Use On Claim checkboxes are checked.

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You should also make sure you enter the provider's NPI number on the Provider Numbers tab as well. If your provider has both a group and an individual NPI number, the NPI number used in this field should be the doctor's individual (Type-1) NPI number.

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You will also need to make sure that your Medicare Insurance reference is set to the correct plan type. MacPractice identifies insurance carriers by their plan type, and the self-referral will not work if the plan type is set to anything other than Medicare Part B.

In the References ability, select Insurance Carriers in the sidebar. Expand the sidebar node and find your Medicare reference(s). On the Plans tab, you will see a Plan Type pop-up menu. Make sure Medicare Part B is selected. Repeat these steps for each Medicare insurance reference and plan that you have in your database.

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Lastly, open the Preferences window, select Claims in the sidebar, and make sure the checkbox labeled Self-Refer Medicare Part B Claims is checked. Close the Preferences window when you are finished.

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Once your references and preferences are set up, you are ready to begin using self-referrals for Medicare. Enter your charges as you normally would, make sure the correct provider is shown, and make sure the Referral area in the charge window is left blank. If a different referring provider appears in this area, then the listed provider will be used instead of the self-referral. As long as no other referral is entered in this field, the self-referral from the user reference will be used.

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