Mar 24, 2012 | Medical billing basics
What Medigap policies don’t cover Medigap policies don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, and private-duty nursing. Types of coverage that are NOT Medigap policies • Medicare Advantage Plans (Part C),...
Mar 21, 2012 | Medical billing basics
What is a Medigap policy? A Medigap (also called “Medicare Supplement Insurance”) policy is private health insurance that is designed to supplement Original Medicare. Th is means it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover...
Mar 18, 2012 | Medical billing basics
Medicare Advantage Plans Medicare Advantage Plans include the following: • Preferred Provider Organization (PPO) Plans • Health Maintenance Organization (HMO) Plans • Private Fee-for-Service (PFFS) Plans • Medical Savings Account (MSA) Plans • Special Needs Plans...
Mar 15, 2012 | Medical billing basics
What is Medicare? Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). Original Medicare covers many...
Mar 12, 2012 | Medical billing basics
A Home Health Agency in the State of Wisconsin is defined as “an organization that primarily provides both skilled nursing and other therapeutic services to patients in their homes,” according to Wisconsin Administrative Code, HFS 133.02. Important Background...
Feb 28, 2012 | Medical billing basics
Are you going to resubmit the claim, make sure all the below points has been reviewd. Resubmission Checklist Use the following checklist to ensure that resubmittals are completed correctly before submitting. * Did you wait thirty days after the original...
Feb 25, 2012 | Medical billing basics
When the Recipient Has Other Insurance Introduction If the recipient has other insurance coverage, Medicaid payment will be denied unless the provider indicates receipt of a third party payment or attaches a denial from the other insurance company or...
Feb 21, 2012 | Medical billing basics
Level of Claims Processing Paper Claim Handling When the Medicaid fiscal agent receives a paper claim, it is screened for missing information and necessary attachments. If information or documentation is missing, the claim will not be entered into the Florida...
Feb 18, 2012 | Medical billing basics
Introduction A Medically Needy recipient is an individual who would qualify for Medicaid, except that the individual’s income or resources exceed Medicaid’s income or resource limits. On a month-by-month basis, the individual’s medical expenses are subtracted...
Feb 14, 2012 | Medical billing basics
Claim Certification Because an electronic claim cannot be submitted with a signature, the provider’s endorsed signature on the back of the remittance check issued by the Medicaid fiscal agent takes the place of a signature on a paper claim form. It acknowledges...
