1. www.hometownhealthonline.com HOW TO BILL AN INPATIENT CLAIM WHEN A PATIENT HAS MEDICARE PART B AND MEDICAID

2. www.hometownhealthonline.com ALL PATIENTS WITH MEDICARE PART B ONLY AND MEDICAID MUST BE PRECERTED WITH MEDICAID!!!

3. www.hometownhealthonline.com Bill Part B as bill type 121 Bill Ancillary Charges to Medicare The next few slides will show you what to bill to Medicare for Part B payments. These were copied off the Medicare Hospital Billing Manual.

4. www.hometownhealthonline.com Services payable by Medicare Part B are: Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests; X-ray, radium, and radioactive isotope therapy, including materials and services of technicians; Surgical dressings, and splints, casts, and other devices used for reduction of fractures and dislocations; Prosthetic devices (other than dental) which replace all or part of an internal body organ (including contiguous tissue), or all or part of the function of a permanently inoperative or malfunctioning internal body organ, including replacement or repairs of such devices; Leg, arm, back, and neck braces, trusses, and artificial legs, arms, and eyes including adjustments, repairs, and replacements required because of breakage, wear, loss, or a change in the patient’s physical condition;

5. www.hometownhealthonline.com Covered Part B Services Continued…. Outpatient physical therapy, outpatient speech- language pathology services, and outpatient occupational therapy (see the Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health Services,” §§220 and 230); Screening mammography services; Screening pap smears; Influenza, pneumococcal pneumonia, and hepatitis B vaccines; Colorectal screening;

6. www.hometownhealthonline.com Covered Part B Services Continued…. Bone mass measurements; Diabetes self-management; Prostate screening; Ambulance services; Hemophilia clotting factors for hemophilia patients competent to use these factors without supervision);

7. www.hometownhealthonline.com Covered Part B Services Continued…. Immunosuppressive drugs; Oral anti-cancer drugs; Oral drug prescribed for use as an acute anti-emetic used as part of an anti-cancer chemotherapeutic regimen; and Epoetin Alfa (EPO).

8. www.hometownhealthonline.com After Medicare Part B pays on these services Medicaid should pay on the cross over claim. If no payment received within 45 days, you may manually key the cross over claim into the web portal for payment.

9. www.hometownhealthonline.com Medicare and Medicaid pays the Ancillaries on the 121 bill type…WHAT TO DO NEXT? File Medicaid NOW on a 111 bill type for the “rest” “REST” is: Accommodations Pharmacy Observation ER OR Any services not listed on the Part B slides.

10. www.hometownhealthonline.com This claim HAS to be sent in HARDCOPY with: Copies of the ORIGINAL 121 UB04 sent to Medicare with the EOB’s from Medicare and Medicaid. Has to be on the red and white form. This claim CANNOT be hand keyed or edited on the WEBPORTAL

11. www.hometownhealthonline.com Bill classification111 should be used. Enter “Medicare Part B” the Primary payer on Line A of Form Locator 50. Enter the amount paid by Medicare and Medicaid under Part B as a prior payment in Form Locator 54.

12. www.hometownhealthonline.com MAIL CLAIM TO: DEPARTMENT OF COMMUNITY HEALTH Third Party Liability Unit 2 Peachtree Street, NW 39 th Floor Atlanta, GA 30303-3159 Mail Certified with RETURN RECEIPT REQUESTED.

13. www.hometownhealthonline.com For some reason, most of these claims have to be sent several times. You can see the claims on the web portal but cannot access them. Wait at least 45 days before “resending” the claims again.