UB-04 Medicare Exhaust Claims

HP Provider Relations October 2011

Agenda

– Objectives – What is a Medicare Exhaust Claim – Billing Part B Charges – Billing Electronically – Completing Paper Claim Form Fields Correctly – Support Documentation – Common Denials – Helpful Tools – Questions 2 UB-04 – Medicare Exhaust Claims October 2011

Objectives

At the end of this session, providers will understand: – What constitutes a Medicare Exhaust claim – How to bill the Part B charges – How to bill a Benefit Exhaust claim electronically – How to bill a Benefit Exhaust claim on the UB-04 claim form – How to identify and notate the supporting documentation – What denials are commonly associated with billing issues associated with a Medicare Benefit Exhaust claim 3 UB-04 – Medicare Exhaust Claims October 2011

Learn

Medicare Exhaust Claims

What Constitutes a Medicare Exhaust Claim?

– Dually eligible member (Medicare and Medicaid coverage) – Indiana Health Coverage Programs (IHCP) member has exhausted his or her Medicare Part A benefits – Benefits exhaust prior to the admission for an inpatient stay – Medicare Remittance Notification (MRN) or online Florida Shared System (FSS) printout indicating exhaust status must accompany the claim to Medicaid –

Do not bill the IHCP for partial inpatient stays

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Part B Charges

– When Part B charges are billed to Medicare before billing the exhaust inpatient claim to IHCP – Medicare Part B claims automatically cross over • Must void the Medicare B crossover claim to prevent the Inpatient claim from denying as a duplicate claim – Must enter the Part B Medicare payment as a third-party liability (TPL) payment 6 UB-04 – Medicare Exhaust Claims October 2011

Bill

Electronic Exhaust Claims

Billing Electronically

– Medicare Benefit Exhaust claims may be submitted electronically via Web interChange using the Attachment feature – The supporting documentation required for the electronic claim is the same as for the paper claim 8 UB-04 – Medicare Exhaust Claims October 2011

Billing Information

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Coordination of Benefits

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Coordination of Benefits

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Billing Information

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Attachment Information

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Claims Attachment Cover Sheet

Information entered must match the claim exactly 14 UB-04 – Medicare Exhaust Claims October 2011

Bill

Paper Exhaust Claims

Paper Billing

Locators 50 through 55 – Part B payments are indicated by entering the word, “Exhaust” in locator 50 on line b of the UB-04 claim form • Do not enter the word “Medicare” in field 50 – The payment is entered in field 54b from Part B – Commercial payments are entered in the same manner – Use line c in fields 50 through 55 for the Medicaid billing 16 UB-04 – Medicare Exhaust Claims October 2011

Paper Billing

Locator 39 – Using value code 80, enter the covered days –

Do not

enter value codes for deductible and coinsurance or blood deductible • A1, A2, or 06 – These claims are processed like TPL claims – All filing limit and prior authorization rules apply – All other UB-04 billing policies apply 17 UB-04 – Medicare Exhaust Claims October 2011

Paper Claim Billing/Benefits Exhausted

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Benefits Exhausted

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Benefits Exhausted

ACN # 1234567

Benefits Exhausted Member 111222333999

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Support Documentation

– In the top margin of the UB-04 claim form, boldly write the words: •

“Benefits Exhausted”

– On the top or bottom of the MRN and/or FSS screen print, boldly write: •

“Benefits Exhausted”

– The information on the supporting documentation must match the information presented for Medicaid claim 21 UB-04 – Medicare Exhaust Claims October 2011

Deny

Common Denials

Common Denials

0558 - Coinsurance and deductible amount missing – Cause • The word “Medicare” has been entered in field 50 on lines a or b – Resolution • Remove the word “Medicare” and enter the word “Exhaust” in 50B 23 UB-04 – Medicare Exhaust Claims October 2011

Common Denials

2501 – This recipient is covered by Medicare Part A; therefore, you must first file claims with Medicare – Cause • Claim has not been submitted indicating “Benefits Exhausted” – Resolution • Write the words “Benefits Exhausted” in the top margin of the UB-04 claim form and on all attachments • Type the words “Benefits Exhausted” in the “Description” section of the Attachment window 24 UB-04 – Medicare Exhaust Claims October 2011

Find Help

Resources Available

Helpful Tools

Avenues of resolution – IHCP website at indianamedicaid.com

– Provider Enrollment • 1-877-707-5750 – Customer Assistance • 1-800-577-1278, or • (317) 655-3240 in the Indianapolis local area – Written Correspondence • P.O. Box 7263 Indianapolis, IN 46207-7263 – Provider Relations field consultant 26 UB-04 – Medicare Exhaust Claims October 2011

Q&A