Presentation on theme: "MEDICARE DEDUCTIBLE AND COINSURANCE Common Billing Errors"— Presentation transcript:
1 MEDICARE DEDUCTIBLE AND COINSURANCE Common Billing Errors TITLE XVIII(DMAS-30)Department of Medical Assistance ServicesFebruary 2010
2 Department of Medical Assistance Services Medicaid PrimaryIf problems are encountered with the Medicare Crossover claim process, the DMAS-30 invoice form should be completed and forwarded to:PractitionerDepartment of Medical Assistance ServicesP. O. Box 27444Richmond, VA
3 Title XVIII Common Mistakes Locator 7 - Other CoverageLocator 8 - Type CoverageLocator 17- Charges to MedicareLocator 18- Allowed By MedicareLocator 19- Paid By MedicareLocator 20- DeductibleLocator 21- CoinsuranceLocator 22- Paid By Carrier Other Than MedicareLocator 23- Patient Pay Amount (LTC Only)
4 01 Billing Provider Number Title XVIII- Block 0101 Billing Provider NumberEnter the provider’s billing or group NPI.
5 06 Rendering Provider Number Title XVIII- Block 0606 Rendering Provider NumberEnter 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 Title XVIII- Block 0707Primary Carrier Information Other Than Medicare2 No Other Coverage5 Billed No Coverage3 Billed and Paid
8 Type Coverage Medicare- Mark type of coverage “B”. Title XVIII- Block 0808Type Of Coverage MedicareType Coverage Medicare- Mark type of coverage “B”.B
9 Title XVIII- Block 1717Charges To MedicareBlock 17: Charges to Medicare- Enter the total charges submitted to Medicare.
10 Title XVIII- Block 1818Allowed By MedicareBlock 18: Allowed by Medicare- Enter the amount of the charges allowed by Medicare.
11 Title XVIII- Block 1919Paid By MedicareBlock 19: Paid by Medicare- Enter the amount paid by Medicare (taken from the EOB).
12 Title XVIII- Block 20Deductible20Block 20: Deductible- Enter the amount of the deductible (taken from the Medicare EOB).
13 Title XVIII- Block 2121Co-InsuranceBlock 21: Coinsurance - Enter the amount of the coinsurance (taken from the Medicare EOB).
14 Paid By Carrier Other Than Title XVIII- Block 2222Paid By Carrier Other ThanMedicareBlock 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.)
16 TITLE XVIII- Adjustment Invoice DMAS-31 Block 1 Adjustment/Void Check the appropriate blockBlock 2 Billing Provider Number Enter the NPI of the billing providerBlock 6 Rendering Provider NumberEnter the NPI of the rendering providerBlock 2A Reference Number Enter the ICN number taken from theRemittance Voucher for the line of payment needingadjustment.
17 TITLE XVIII- Adjustment Invoice Blocks 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 Department of Medical Assistance Services www.dmas.virginia.gov THANK YOUDepartment of Medical Assistance Services