May 16, 2014 | Medical billing basics
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 but denies the others, the paid line(s) (as...
May 9, 2014 | Medical billing basics
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 B) and Medicaid. Will Medicare Crossover process affect...
Apr 28, 2014 | Medical billing basics
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 amount and then automatically forward the claim to Medicaid....
Apr 10, 2014 | Medical billing basics
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 than 135 percent of the FPL; ■ has resources...
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...
