Apr 4, 2014 | Medical billing basics
Dual Eligible Medicare Beneficiary Groups See 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 that does not exceed 100 percent of the...
Mar 27, 2014 | Medical billing basics
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. Coverage for Part A is automatic for individuals age 65 or older (and for...
Mar 21, 2014 | Medical billing basics
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 as waiver programs, Office on Aging funds, community agencies...
Mar 13, 2014 | Medical billing basics
HHA Triggering Events HHAs 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 Description Initiation When an HHA expects that...
Mar 7, 2014 | Medical billing basics
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 Beneficiary Notice of Noncoverage (ABN) to replace the outgoing Home...
Feb 27, 2014 | Medical billing basics
Crosswalk did not give 1 to 1 match for NPI What this means: The payer does not recognize the provider matched to the NPI tax ID combination in thier system. Provider action: Check your NPI and tax ID numbers, are you sending the claim how you are credentialled...
