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HOW TO BILL AN INPATIENT CLAIM WHEN A PATIENT HAS MEDICARE

PART B AND MEDICAID


HOMETOWN HEALTH

ALL PATIENTS WITH MEDICARE PART B ONLY AND MEDICAID MUST BE PRECERTED WITH MEDICAID!!!


Bill Part B as bill type 121Bill Ancillary Charges to MedicareThe next few slides will show you what to bill to Medicare for Part B payments.These were copied off the Medicare Hospital Billing Manual.


Services payable by Medicare Part B are:

• Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests;

• X-ray, radium, and radioactive isotope therapy, including materials and services of technicians;

• Surgical dressings, and splints, casts, and other devices used for reduction of fractures and dislocations;

• Prosthetic devices (other than dental) which replace all or part of an internal body organ (including contiguous tissue), or all or part of the function of a permanently inoperative or malfunctioning internal body organ, including replacement or repairs of such devices;

• Leg, arm, back, and neck braces, trusses, and artificial legs, arms, and eyes including adjustments, repairs, and replacements required because of breakage, wear, loss, or a change in the patient’s physical condition;


Covered Part B Services Continued….

• Outpatient physical therapy, outpatient speech-language pathology services, and outpatient occupational therapy (see the Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health Services,” §§220 and 230);

• Screening mammography services;

• Screening pap smears;

• Influenza, pneumococcal pneumonia, and hepatitis B vaccines;

• Colorectal screening;



• Bone mass measurements;

• Diabetes self-management;

• Prostate screening;

• Ambulance services;

• Hemophilia clotting factors for hemophilia patients competent to use these factors without supervision);



• Immunosuppressive drugs;

• Oral anti-cancer drugs;

• Oral drug prescribed for use as an acute anti-emetic used as part of an anti-cancer chemotherapeutic regimen; and

• Epoetin Alfa (EPO).


After Medicare Part B pays on these services Medicaid should pay on the cross over claim.

If no payment received within 45 days, you may manually key the cross over claim into the web portal for payment.


Medicare and Medicaid pays the Ancillaries on the 121 bill type…WHAT TO DO NEXT?

File Medicaid NOW on a 111 bill type for the “rest”“REST” is:AccommodationsPharmacyObservationERORAny services not listed on the Part B slides.


This claim HAS to be sent in HARDCOPY with:

Copies of the ORIGINAL 121 UB04 sent to Medicarewith the EOB’s from Medicare and Medicaid.Has to be on the red and

white form.

This claim CANNOT be hand keyed or edited on the WEBPORTAL


Bill classification111 should be used. Enter “Medicare Part B” the Primary payer on Line A of Form Locator 50.Enter the amount paid by Medicare and Medicaid under Part B as a prior payment in Form Locator 54.


MAIL CLAIM TO:DEPARTMENT OF COMMUNITY

HEALTHThird Party Liability Unit2 Peachtree Street, NW 39th FloorAtlanta, GA 30303-3159

Mail Certified with RETURN RECEIPT REQUESTED.


For some reason, most of these claims have to be sent several times.

You can see the claims on the web portal but cannot access them.

Wait at least 45 days before “resending” the claims again.

Date post:	24-Feb-2016
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