ABN notice for - Home health agency
Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 This article is based on Change Request (CR) 8404 which provides: 1) instructions for Home Health Agency (HHA) use of the Advance...
View ArticleWhat are cases can HHA give ABN TO beneficiary - time period of ABN
HHA Triggering EventsHHAs may be required to provide an ABN to an Original Medicare beneficiary when a triggering event occurs. Table 2, below, outlines triggering events specific to HHAs. Event...
View ArticleMedicare ABN - If patient has other insurance - what is the procedure
Effect of Other Insurers/Payers If a beneficiary is eligible for both Original Medicare and Medicaid (dually eligible) or is covered by Original Medicare and another insurance program or payer (such...
View ArticleMedicaid Coverage of Medicare Beneficiaries (Dual Eligibles) at a Glance -...
The Original Medicare Program, Title XVIII of the Social Security Act (SSA), provides hospital insurance, known as Part A coverage, and supplementary medical insurance, known as Part B coverage....
View ArticleMedicaid Coverage of Medicare Beneficiaries (Dual Eligibles) at a Glance -...
Dual Eligible Medicare Beneficiary GroupsSee the First part for better understanding.Qualified Medicare Beneficiary (QMB Only)A QMB is an individual who: ■ is entitled to Medicare Part A; ■ has income...
View ArticleMedicaid Coverage of Medicare Beneficiaries (Dual Eligibles) at a Glance -...
See the First and second part for better understanding.Qualifying Individual (QI)A QI is an individual who: ■ is entitled to Part A; ■ has income that is at least 120 percent of the ■ FPL, but less...
View ArticleHow can we know Medicare crossed over the claims to Medicaid?
1. What is meant by the crossover payment?When Medicaid providers submit claims to Medicare for Medicare/Medicaid beneficiaries, Medicare will pay the claim, apply a deductible/coinsurance or co-pay...
View ArticleWill Medicare cross over claims with no patient responsibilities? Clinic...
How does the Medicare Crossover process affect my Medicaid billing? You will no longer need to submit claims directly to Medicaid for those Medicaid patients who have both Medicare (Parts A &/or...
View ArticleMedicare and Medicaid cross over claim - with different NPI
If a claim is submitted to Medicare and 3 lines pay and 2 deny--will the two denied lines crossover on that claim? If a provider bills multiple lines to Medicare and Medicare pays one or more lines...
View ArticleHIPAA Understand the basics.
HIPAA is the acronym for the Health Insurance Portability and Accountability Act. Although HIPAA covers many things, physicians typically are most concerned with HIPAA’s Administrative Simplification...
View ArticleHIPAA - some important website resources
Look to the AMA and website resources for updates. The HIPAA Privacy, Security and Breach Notification rules continue to be revised, and technologicalchange continues to impact the application of those...
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Important update from PUP
ALL CMS PUP patient would be moved Medicare from June 1. We could submit the claim to Medicare and get paid See the below notice form PUP.
View ArticleElectronic vs. Paper Billing - basic overview from Molina insurance
Medicaid claims that are secondary to insurance or Medicare coverage, including Medicare HMOs, may be billed electronically either through electronic vendors or through Molina’s web portal....
View ArticleProcedure codes with modifier 22
An internal system processing issue has caused some surgical procedure codes billed with modifier 22 processed on/after January 1, 2014, to not allow any additional money above the fee schedule. First...
View ArticleReceipt Date - Medicare definition
The receipt date of a claim is the date the contractor receives the claim (provided the filing is in a format and contains data sufficiently complete so that the filing qualifies as a claim). The...
View ArticleProcedure codes with modifier 22 - Medicare internal issue
An internal system processing issue has caused some surgical procedure codes billed with modifier 22 processed on/after January 1, 2014, to not allow any additional money above the fee schedule. First...
View ArticleMedicare - Payment Ceiling Standards - Payment days
Payment ceilings were implemented for clean claims received by the carrier or FI on or after April 1, 1987. “Clean” claims must be paid or denied within the applicable number of days from their receipt...
View ArticleMedicare deductible, coins - can we collect from patient when patient have...
The Medicare ProgramThe Original Medicare Program, also known as Fee-For-Service (FFS) Medicare, consists of:• Part A, hospital insurance; and• Part B, medical insurance.Under FFS Medicare, eligible...
View ArticleMedicare provider Enrollment time frame - How to make it quicker
How you can expedite your enrollment application processAs the Medicare administrative contractor (MAC) for jurisdiction N (JN), First Coast Service Options Inc. (First Coast) is not only responsible...
View ArticleHow Medicare Determining and Paying Interest
The contractor must pay interest on clean, non-PIP (FIs) claims for which it does not make payment within the payment ceiling specified in § 80.2.1.1, provided payment is due on such claim. The...
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