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HP Provider Relations October 2011 UB-04 Medicare Exhaust Claims.

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Presentation on theme: "HP Provider Relations October 2011 UB-04 Medicare Exhaust Claims."— Presentation transcript:

1 HP Provider Relations October 2011 UB-04 Medicare Exhaust Claims

2 UB-04 – Medicare Exhaust ClaimsOctober Agenda –Objectives –What is a Medicare Exhaust Claim –Billing Part B Charges –Billing Electronically –Completing Paper Claim Form Fields Correctly –Support Documentation –Common Denials –Helpful Tools –Questions

3 UB-04 – Medicare Exhaust ClaimsOctober Objectives At the end of this session, providers will understand: –What constitutes a Medicare Exhaust claim –How to bill the Part B charges –How to bill a Benefit Exhaust claim electronically –How to bill a Benefit Exhaust claim on the UB-04 claim form –How to identify and notate the supporting documentation –What denials are commonly associated with billing issues associated with a Medicare Benefit Exhaust claim

4 Learn Medicare Exhaust Claims

5 UB-04 – Medicare Exhaust ClaimsOctober What Constitutes a Medicare Exhaust Claim? –Dually eligible member (Medicare and Medicaid coverage) –Indiana Health Coverage Programs (IHCP) member has exhausted his or her Medicare Part A benefits –Benefits exhaust prior to the admission for an inpatient stay –Medicare Remittance Notification (MRN) or online Florida Shared System (FSS) printout indicating exhaust status must accompany the claim to Medicaid –Do not bill the IHCP for partial inpatient stays

6 UB-04 – Medicare Exhaust ClaimsOctober Part B Charges –When Part B charges are billed to Medicare before billing the exhaust inpatient claim to IHCP –Medicare Part B claims automatically cross over Must void the Medicare B crossover claim to prevent the Inpatient claim from denying as a duplicate claim –Must enter the Part B Medicare payment as a third-party liability (TPL) payment

7 Bill Electronic Exhaust Claims

8 UB-04 – Medicare Exhaust ClaimsOctober Billing Electronically –Medicare Benefit Exhaust claims may be submitted electronically via Web interChange using the Attachment feature –The supporting documentation required for the electronic claim is the same as for the paper claim

9 UB-04 – Medicare Exhaust ClaimsOctober Billing Information

10 UB-04 – Medicare Exhaust ClaimsOctober Coordination of Benefits

11 UB-04 – Medicare Exhaust ClaimsOctober Coordination of Benefits

12 UB-04 – Medicare Exhaust ClaimsOctober Billing Information

13 UB-04 – Medicare Exhaust ClaimsOctober Attachment Information

14 UB-04 – Medicare Exhaust ClaimsOctober Claims Attachment Cover Sheet Information entered must match the claim exactly

15 Bill Paper Exhaust Claims

16 UB-04 – Medicare Exhaust ClaimsOctober Paper Billing Locators 50 through 55 –Part B payments are indicated by entering the word, Exhaust in locator 50 on line b of the UB-04 claim form Do not enter the word Medicare in field 50 –The payment is entered in field 54b from Part B –Commercial payments are entered in the same manner –Use line c in fields 50 through 55 for the Medicaid billing

17 UB-04 – Medicare Exhaust ClaimsOctober Paper Billing Locator 39 –Using value code 80, enter the covered days –Do not enter value codes for deductible and coinsurance or blood deductible A1, A2, or 06 –These claims are processed like TPL claims –All filing limit and prior authorization rules apply –All other UB-04 billing policies apply

18 UB-04 – Medicare Exhaust ClaimsOctober Paper Claim Billing/Benefits Exhausted

19 UB-04 – Medicare Exhaust ClaimsOctober Benefits Exhausted

20 UB-04 – Medicare Exhaust ClaimsOctober Benefits Exhausted ACN # Benefits Exhausted Member

21 UB-04 – Medicare Exhaust ClaimsOctober Support Documentation –In the top margin of the UB-04 claim form, boldly write the words: Benefits Exhausted –On the top or bottom of the MRN and/or FSS screen print, boldly write: Benefits Exhausted –The information on the supporting documentation must match the information presented for Medicaid claim

22 Deny Common Denials

23 UB-04 – Medicare Exhaust ClaimsOctober Common Denials Coinsurance and deductible amount missing –Cause The word Medicare has been entered in field 50 on lines a or b –Resolution Remove the word Medicare and enter the word Exhaust in 50B

24 UB-04 – Medicare Exhaust ClaimsOctober Common Denials 2501 – This recipient is covered by Medicare Part A; therefore, you must first file claims with Medicare –Cause Claim has not been submitted indicating Benefits Exhausted –Resolution Write the words Benefits Exhausted in the top margin of the UB-04 claim form and on all attachments Type the words Benefits Exhausted in the Description section of the Attachment window

25 Find Help Resources Available

26 UB-04 – Medicare Exhaust ClaimsOctober Helpful Tools Avenues of resolution –IHCP website at indianamedicaid.com indianamedicaid.com –Provider Enrollment –Customer Assistance , or (317) in the Indianapolis local area –Written Correspondence P.O. Box 7263 Indianapolis, IN –Provider Relations field consultant

27 Q&A


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