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MEDICARE DEDUCTIBLE AND COINSURANCE Common Billing Errors TITLE XVIII (DMAS-30) Department of Medical Assistance Services February 2010 www.dmas.virginia.gov.

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Presentation on theme: "MEDICARE DEDUCTIBLE AND COINSURANCE Common Billing Errors TITLE XVIII (DMAS-30) Department of Medical Assistance Services February 2010 www.dmas.virginia.gov."— Presentation transcript:

1 MEDICARE DEDUCTIBLE AND COINSURANCE Common Billing Errors TITLE XVIII (DMAS-30) Department of Medical Assistance Services February 2010

2 Medicaid Primary If problems are encountered with the Medicare Crossover claim process, the DMAS-30 invoice form should be completed and forwarded to: Practitioner Department of Medical Assistance Services P. O. Box Richmond, VA

3 Title XVIII Common Mistakes Locator 7 - Other Coverage Locator 8 - Type Coverage Locator 17- Charges to Medicare Locator 18- Allowed By Medicare Locator 19- Paid By Medicare Locator 20- Deductible Locator 21- Coinsurance Locator 22- Paid By Carrier Other Than Medicare Locator 23- Patient Pay Amount (LTC Only)

4 Title XVIII- Block Billing Provider Number Enter the provider’s billing or group NPI.

5 Title XVIII- Block Rendering Provider Number Enter the rendering provider’s NPI.

6 Block 7 Patient only has Medicare and Medicaid coverage- Check 2 Patient has Medicare coverage primary and a secondary plan which has paid on the deductible or coinsurance amount- Check 3 and write the amount paid in Block 22. Patient has Medicare primary and a secondary plan which has denied the service, or applied the coinsurance to deductible- Check 5 and attach the secondary carrier’s Explanation of Benefits.

7 Primary Carrier Information Other Than Medicare Title XVIII- Block No Other Coverage 5 Billed No Coverage 3 Billed and Paid

8 Type Of Coverage Medicare B Title XVIII- Block 08 Type Coverage Medicare- Mark type of coverage “B”. 08

9 Title XVIII- Block 17 Charges To Medicare Block 17: Charges to Medicare- Enter the total charges submitted to Medicare. 17

10 Title XVIII- Block 18 Allowed By Medicare Block 18: Allowed by Medicare- Enter the amount of the charges allowed by Medicare. 18

11 Title XVIII- Block 19 Paid By Medicare Block 19: Paid by Medicare- Enter the amount paid by Medicare (taken from the EOB). 19

12 Title XVIII- Block 20 Deductible Block 20: Deductible- Enter the amount of the deductible (taken from the Medicare EOB). 20

13 Title XVIII- Block 21 Co-Insurance Block 21: Coinsurance - Enter the amount of the coinsurance (taken from the Medicare EOB). 21

14 Title XVIII- Block 22 Paid By Carrier Other Than Medicare Block 22: Paid by Carrier Other Than Medicare- Enter the payment received from the secondary carrier (other than Medicare). If Code 3 is marked in Block 7, enter an amount in this block. (Do not include the Medicare payment.) 22

15 Title XVIII- Block 23 Patient Pay Amt. LTC Only Block 23: Patient Pay Amount, LTC Only- Leave Blank. 23

16 TITLE XVIII- Adjustment Invoice DMAS-31 Block 1 Adjustment/Void Check the appropriate block Block 2 Billing Provider Number Enter the NPI of the billing provider Block 6Rendering Provider Number Enter the NPI of the rendering provider Block 2A Reference Number Enter the ICN number taken from the Remittance Voucher for the line of payment needing adjustment.

17 TITLE XVIII- Adjustment Invoice Blocks 3-20 Refer to instructions for the DMAS-31 for the completion of these blocks. Remarks This section of the invoice should be used to give a brief explanation of the change needed. Signature Signature of the provider or agent and the date signed.

18 THANK YOU Department of Medical Assistance Services


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