Medicare G Codes
G2211
G2211 - Reflects the time, intensity, and practice expense resources involved when physicians provide office/outpatient visits that build longitudinal relationships with patients and address the majority of a patient's health care needs with consistency and continuity over longer periods of time.
G0403 - EKG
Medicare only covers EKG/ECG with Welcome to Medicare Visit
Part A Coverage
Hospital coverage – Free from the government if customer has worked more than 10 yrs. is USA. Effective first of the month in which they turn age 65.
AWV
Annual Wellness Visit
E/M
Evaluation and Management
G0402
INITIAL Preventative - AKA Welcome to Medicare Visit
G0101
Every 24 months unless considered high risk
Part B Coverage
Physician coverage – not free, there is a premium. There is a yearly deductible and then covered at 80%. Eligible first of the month in which they turn age 65.
QMB
Customer has both Medicare and Medicaid – we cannot collect any $$$
(The coverage shows that it is a Dual coverage plan)
What is the Medicare Part B co-insurance?
20% is PR
G0438
NEW Patient Medicare Wellness Visit
Tetanus - Part B Medicare
After qualified injury/illness
Supplemental
Supplemental plans will usually cover the 20% after Medicare pays the 80%.
Supplemental plans C and F are the only ones that will cover the Medicare Part B deductible – all other supplemental plans will not; and the customer will be liable.
Dual Plan
Customer has both Medicare and Medicaid – we cannot collect any $$$
What is Medicare Deductible for 2024
$240
G0439
ESTABLISHED Patient Medicare Wellness Visit
Q0091
Pap - every 24 months unless high risk
Part C
Medicare Advantage plans (Part C) – is with commercial insurance and has low premium or no premium. Advantage plans take Medicare and commercial insurance and “wrap it together” or combines it as one plan. Usually has a copay and no further customer balance.
CMS
CMS – Center for Medicare and Medicaid Services
Patient tells you they have Aetna Advantage and statement is shows claim only went to Aetna and it needs to go to Medicare to, what actions are needed.
....
G0101
Routine OBGYN Medicare Exam
Shingles
Covered by Part D
Patient will need to receive at Pharmacy or may be responsible
Part D
Prescription coverage
ABN
Advance Beneficiary Notice of Noncoverage (ABN), is issued by medical providers to beneficiaries of Medicare and lets them know what services might not be covered
What is the Medicare Dunning Cycle
Day 0 - statements are going to WQ 77010
Day 30 - 1st statement sent to patient
Day 60 - 2nd statement sent to patient
Day 90 - 3rd statement sent to patient
Day 120 - (pre-collections)
Day 130 - patient is placed in bad debt (collections)