When a Part A claim is processed by Medicare, Medicare pays the provider directly for the service rendered by the provider. On the other hand, in a Part B claim, who pays depends on who has accepted the assignment of the claim. If the provider accepts the assignment of the claim, Medicare pays the provider 80% of the cost of the procedure, and the remaining 20% of the cost is passed on to the patient. You should recognized that 80-20 breakdown: it’s a classic example of coinsurance.
Medicare & Medicaid Cost Report l Owner Administrator Forum Seminar
Medicare Training & Consulting, Inc., was founded by Jim Plonsey in the Chicago area. After training Medicare auditors for Blue Cross Association, Jim established a business training Medicare auditors. This lead to doing cost reimbursement seminars for providers, most notably, home health agencies. Medicare Training & Consulting, Inc. has become a leader in providing Owners and Administrators with the reimbursement strategies.
Medicare Billing Noncovered Services for Skilled Nursing Facilities
Harmony frequently receives calls inquiring about completion of No-Pay Bills and Benefits Exhaust Claims. The SNF is REQUIRED to submit a bill for the Medicare beneficiary for every month of the SNF stay even when no Medicare benefits are payable. The SNF must submit a claim when the patient has exhausted the 100 SNF days. This claim is referred to as a Benefits Exhaust Bill. The SNF must submit a claim when the beneficiary no longer needs Skilled Care. This claim is referred to as a No-Pay Bill. These billing requirements are in place because the Centers for Medicare and Medicaid Services (CMS) will maintain a record of all inpatient services for each Medicare beneficiary whether reimbursable or not. The Medicare Contractor NHIC which covers Jurisdiction 14, recently conducted a Question and Answer session on this topic addressing many commonly asked questions. We have posted several of our favorites:
Medicare Billing of Audiology Services
For treatment of auditory processing disorders or auditory rehabilitation/auditory training (including speech-reading or lip-reading), 92507, and 92508 are used to report a single encounter with “1” as the unit of service, regardless of the duration of the service on a given day. These codes always represent SLP services. See Pub. 100-02, chapter 15, sections 220 and 230 [PDF, 1.6MB] for SLP policies. These SLP evaluation and treatment services are not covered when performed or billed by audiologists, even if they are supervised by physicians or qualified NPPs. For evaluation of auditory rehabilitation to instruct the use of residual hearing provided by an implant or hearing aid related to hearing loss, the timed codes 92626 and 92627 are used. These are not “always therapy” codes. Evaluation of auditory rehabilitation shall be appropriately provided and billed by an audiologist or speech-language pathologist. Also, these services may be provided incident to a physician’s or qualified NPP’s service by a speech-language pathologist, or personally by a physician or qualified NPP within their scope of practice. Evaluation of auditory rehabilitation is a covered diagnostic test when performed and billed by an audiologist and is an SLP evaluation service covered under the SLP benefit when performed by a speech-language pathologist.