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 Automatic (If case is appropriately coded):  If client is receiving Medicare Part A when they apply.  Contact Buy-in Unit:  If client is eligible.

Published byShona Banks Modified over 8 years ago

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Presentation on theme: " Automatic (If case is appropriately coded):  If client is receiving Medicare Part A when they apply.  Contact Buy-in Unit:  If client is eligible."— Presentation transcript:

1  Automatic (If case is appropriately coded):  If client is receiving Medicare Part A when they apply.  Contact Buy-in Unit:  If client is eligible for but not receiving Medicare Part A. How Buy-In Works

2  Process - Client Eligible For OHP Plus:  Code all current OHP Plus eligibility (Usually OSIPM).  Receives Part A (no cost)/Receives Part B:  Code Case. No additional action required. Note: Set Tickler for disabled OSIPM clients receiving SSDI (mostly SSDI/SSI combo cases or SSDI Service cases), but have not met the 2 year SSDI requirement. How Buy-In Works

3  Process - Client Eligible For OHP Plus (Cont.):  Receives Part A (no cost)/No Part B:  If eligible for QMB-BAS:  Code with MIB 2 (Medicare A & D in Health Ins. tab of ACCESS) & FS1 C/D; Note: No QMB Med Prg/#, No QMM C/D.  Wait for confirmation from Buy-in unit;  Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMM FS1 C/D. How Buy-In Works

4  Process - Client Eligible For OHP Plus (Cont.):  Receives Part A (no cost)/No Part B (Cont):  If eligible for SMB/SMF:  Code with MIB 2 (Medicare A & D in Health Ins. tab of ACCESS) & FS2 C/D; Note: No SMB/SMF Med Prg/#, No SMB/SMF C/D.  Wait for confirmation from Buy-in unit;  Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), SMB/SMF Med Prg/#, SMB/SMF FS2 C/D.  All other OHP Plus (SBI):  Code with MIB 2 (Medicare A & D in Health Ins. tab of ACCESS) & FS2 C/D;  Wait for confirmation from Buy-in unit;  Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), SBI FS2 C/D. How Buy-In Works

5  Process - Client Eligible For OHP Plus (Cont.):  No Part A/ Receives Part B:  If Otherwise eligible for QMB-BAS:  Code with MIB 1 (Medicare B & D in Health Ins. tab of ACCESS) & FS1 C/D; Note: No QMB Med Prg/#, No QMM C/D.  Contact Buy-in Unit for Part A, wait for response;  Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMM FS1 C/D.  All other OHP Plus (SBI):  Code with MIB 1 (Medicare B & D in Health Ins. tab of ACCESS), FS2 & SBI C/D. How Buy-In Works

6  Process - Client Eligible For OHP Plus (Cont.):  No Part A/No Part B  Complete DHS 1460B and give to client:DHS 1460B  Client needs to take form to local SSA office to sign up for Medicare;  SSA will then contact Buy-In unit;  Once the Buy-In unit has set up for buy-in, and buy-in has processed, they will contact worker to code for QMB-BAS, QMB-SMB/SMF or SBI; Note: SSA normally contacts the buy-in unit very quickly (sometimes same day) when they receive a 1460B from our client. Staff should set Tickler for 2 weeks to follow-up with the Buy-In unit. How Buy-In Works

7  Process - Client Not Eligible For OHP Plus:  Receives Part A (no cost)/ Receives Part B.  Code Case. No additional action required. How Buy-In Works

8  Process - Client Not Eligible For OHP Plus (Cont.):  Receives Part A (no cost) / No Part B:  If Otherwise eligible for QMB-BAS:  Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMB FS1 C/D;  Set Tickler to confirm buy-in.  If Otherwise eligible for QMB-SMB/SMF:  Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), SMB/SMF Med Prg/#, SMB/SMF FS2 C/D;  Set Tickler to confirm buy-in. How Buy-In Works

9  Process - Client Not Eligible For OHP Plus (Cont.):  No Part A / Receives Part B:  If Otherwise eligible for QMB-BAS:  Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMB FS1 C/D. Open case effective 1 st day of following month;  Contact Buy-in unit for Part A;  Set Tickler to confirm buy-in. How Buy-In Works

10  Process - Client Not Eligible For OHP Plus (Cont.):  No Part A / No Part B:  If Otherwise eligible for QMB-BAS:  Complete DHS 1460B and give to client;  Client needs to take form to local SSA office to sign up for Medicare Part B;  Set up pended case and narrate;  SSA will then Contact Buy-In unit;  Set Tickler to confirm Part B buy-in;  Once the Buy-In unit has set up for Part B buy-in, and it has processed, they will contact worker;  Once Part B buy-in confirmed proceed as “No Part A / Receives Part B” from previous slide. How Buy-In Works

11  Retroactive Buy-In (SMB/SMF):  For P2 clients only.  Determine eligibility month-by-month for retro.  Code as normal (can go back to first of previous month on CM).  Send 148 for remainder.  Contact Buy-In unit with retro dates. How Buy-In Works

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