Medicare
What different types of Medicare are there?
Part A, B and C
Does does MR stand for?
Medicare Replacement
What document would you refer too if you need to determine the correct filing order?
Coordination of Benefit
What is Hospice?
End of Life care
What does MSPQ stand for?
Medicare secondary payor questionnaire
How old does someone have to be to typically qualify for Medicare?
65
What Coverage field is a requirement when adding a Medicare Replacement?
Medicare Subscriber ID field (MBI)
What is Coordination of Benefits?
COB determines which insurance pays first when multiple coverages exist. Accurate COB prevents duplicate payments, reduces denials, and improves reimbursement.
True or False: Attach Medicare Part A onto the filing order if patient has a Replacement plan.
False. If enrolled in Hospice, Medicare Part A HB only must be remain available for billing purposes. Do not attach to filing order.
What is the Group name for a Medigap Plan?
SUPPLEMENT
What does MBI stand for?
Medicare Beneficiary Identification
What are some offered carriers (plans) for Replacements?
Blue Cross, Humana, Medica, Ucare
What does Other Payers Found mean?
A payer identified additional coverage for the patient. Staff must verify coverage in EEVE and determine the correct filing order.
What area in the EEVE response do we obtain the NPI/HCFA Provider ID number?
Other Entities
What are the 4 different MSPQ options when Medicare is secondary in the filing order?
Black Lung, Disabled Beneficiary under 65 with LGHP, ESRD Beneficiary in the Mandated Coordination Period with an EGHP and Working Aged Beneficiary/Spouse with EGHP
If someone has a new MBI (Medicare Beneficiary Identification), what policy would we refer to see the process for adding the new MBI?
SR-001 Policy
If Medicare indicates in the EEVE Response patient has a Replacement, what should you do?
Term Medicare. Refer to SR-001 policy (Terminate previous coverage), attempt to add Replacement, if unable to locate coverage mark as self pay and add your appropriate self pay message and COB message
What does the COB birthday rule mean?
For dependent children covered by both parents, the parent whose birthday occurs earlier in the year is primary. Same birthday: longest active plan is primary
What two plan codes are used for Hospice Coverage?
1683 (Allina) or 330 (Non-Allina)
What is a Medicare Cost plan?
Can act like a Replacement Plan for professional billing and a Supplement Plan for hospital billing.
What type of appointment message is left if Medicare is stating patient has additional coverage?
Coordination of Benefit message
True or False: Medicare and a Medicare Replacement/MSHO plan can be billed together in the same filing order
False, Traditional Medicare is NOT billed when a Replacement or MSHO plan exists.
If Medicare is on the account with Medicaid, which one is primary?
Medicare
When checking Hospice benefit dates, if benefit date is within the date of service, what is the next step?
Create a Hospice Guarantor
What are the 4 different Covered Through field options?
Current Employment, Retirement, Cobra and Other