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October 2009 Billing Medicare Part A Benefit Exhaust Claims Presented by EDS Provider Field Consultants.

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Presentation on theme: "October 2009 Billing Medicare Part A Benefit Exhaust Claims Presented by EDS Provider Field Consultants."— Presentation transcript:

1 October 2009 Billing Medicare Part A Benefit Exhaust Claims Presented by EDS Provider Field Consultants

2 Billing Medicare Part A Benefit Exhaust Claims 2/ October 2009 Agenda Objectives What is a Medicare Benefit Exhaust Claim Billing Part B Charges Billing Electronically Paper Billing Locators 50 through 54 Paper Billing Locator 39 Supporting Documentation Common Denials Helpful Tools Questions

3 Billing Medicare Part A Benefit Exhaust Claims 3/ October 2009 Objectives At the end of this session, providers will understand: What constitutes a Medicare Benefit 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 Billing Medicare Part A Benefit Exhaust Claims 4/ October 2009 What Constitutes a Medicare Exhaust Claim Dually eligible member (Medicare and Medicaid coverage) 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

5 Billing Medicare Part A Benefit Exhaust Claims 5/ October 2009 Part B Charges Part B charges must be billed to Medicare before billing the exhaust inpatient claim to IHCP –Include Part B charges on the Part A Medicare claim Medicare Part B claims automatically crossover Must void the Medicare B crossover claim –Inpatient claim will deny as a duplicate claim if Part B claim is not voided Must enter the Part B Medicare payment as a third-party liability (TPL) payment

6 Billing Medicare Part A Benefit Exhaust Claims 6/ October 2009 Medicare Benefit Exhaust claims may be submitted electronically via Web interChange using the Attachment feature Benefits Exhausted must be typed in the Notes field of the claim submission screen The supporting documentation required for the electronic claim is the same as for the paper claim Billing Electronically

7 Billing Medicare Part A Benefit Exhaust Claims 7/ October 2009 Billing Information

8 Billing Medicare Part A Benefit Exhaust Claims 8/ October 2009 Claim Note Information

9 Billing Medicare Part A Benefit Exhaust Claims 9/ October 2009 Attachment Information

10 Billing Medicare Part A Benefit Exhaust Claims 10/ October 2009 Benefits Exhausted

11 Billing Medicare Part A Benefit Exhaust Claims 11/ October 2009 Claims Attachment Cover Sheet

12 Billing Medicare Part A Benefit Exhaust Claims 12/ October 2009 Coordination of Benefits

13 Billing Medicare Part A Benefit Exhaust Claims 13/ October 2009 Demonstrate the fields of input for an Exhaust claim Demonstrate the attachment control number (ACN) process Demonstrate the Notes process Electronic Billing Demonstration

14 Billing Medicare Part A Benefit Exhaust Claims 14/ October 2009 Providers must verify member eligibility to determine if the patient is enrolled in Traditional Medicaid including Care Select These claims are billed on the UB-04 claim form Part B payments are indicated by entering the word, Exhaust in locator 50 on lines a or b –Do not enter the word Medicare on the claim The payment is entered in field 54 Commercial payments are entered in the same manner Use line c in fields 50 through 55 for the Medicaid billing Paper Billing Locators 50 through 55

15 Billing Medicare Part A Benefit Exhaust Claims 15/ October 2009 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 TPL claims All other UB-04 billing policies apply Locator 39 Paper Billing

16 Billing Medicare Part A Benefit Exhaust Claims 16/ October 2009 DRAFT Paper Billing

17 Billing Medicare Part A Benefit Exhaust Claims 17/ October 2009 Benefits Exhausted

18 Billing Medicare Part A Benefit Exhaust Claims 18/ October 2009 Benefits Exhausted

19 Billing Medicare Part A Benefit Exhaust Claims 19/ October 2009 In the top or bottom margin of the UB-04 claim form boldly write the words: – Benefits Exhausted On the top of the MRN or FSS screen print boldly print: –Benefits Exhausted –IHCP Member ID number The information on the supporting documentation must match the information presented for Medicaid claim Claims are Medicaid primary; all filing limit and prior authorization rules apply to these claims Support Documentation

20 Billing Medicare Part A Benefit Exhaust Claims 20/ October 2009 Common Denials Coinsurance and deductible amount missing Cause – The word Medicare has been entered in field 50 on lines a, b, or c Resolution – Remove the word Medicare from field 50

21 Billing Medicare Part A Benefit Exhaust Claims 21/ October 2009 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 or bottom margin of the UB-04 claim form. Type the words Benefits Exhausted in the Notes section of the electronic bill.

22 Billing Medicare Part A Benefit Exhaust Claims 22/ October 2009 IHCP Web site at IHCP Provider Manual (Web, CD-ROM, or paper) Customer Assistance –Local (317) –All others Written Correspondence –EDS Provider Written Correspondence –P. O. Box 7263 –Indianapolis, IN Provider field consultant Avenues of Resolution Helpful Tools

23 Billing Medicare Part A Benefit Exhaust Claims 23/ October 2009 Questions

24 October 2009 EDS and the EDS logo are registered trademarks of Hewlett-Packard Development Company, LP. HP is an equal opportunity employer and values the diversity of its people. © 2009 Hewlett-Packard Development Company, LP. Office of Medicaid Policy and Planning (OMPP) 402 W. Washington St, Room W374 Indianapolis, IN EDS, an HP Company 950 N. Meridian St., Suite 1150 Indianapolis, IN 46204


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