Transcript DMAS-30 (Title 18) Common Billing Errors

MEDICARE
DEDUCTIBLE AND COINSURANCE
Common Billing Errors
TITLE XVIII
(DMAS-30)
Department of Medical
Assistance Services
February 2010
www.dmas.virginia.gov
Medicaid Primary
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If problems are encountered with the Medicare
Crossover claim process, the DMAS-30 invoice
form should be completed and forwarded to:
Practitioner
Department of Medical Assistance Services
P. O. Box 27444
Richmond, VA 23261-7444
Title XVIII Common Mistakes
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Locator 7 - Other Coverage
Locator 8 - Type Coverage
Locator 17- Charges to Medicare
Locator 18- Allowed By Medicare
Locator 19- Paid By Medicare
Locator 20- Deductible
Locator 21- Coinsurance
Locator 22- Paid By Carrier Other Than
Medicare
Locator 23- Patient Pay Amount (LTC Only)
Title XVIII- Block 01
01 Billing Provider Number
Enter the provider’s billing or group NPI.
Title XVIII- Block 06
06 Rendering Provider Number
Enter the rendering provider’s NPI.
Block 7
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Patient only has Medicare and Medicaid
coverage- Check 2
Patient has Medicare coverage primary and a
secondary plan which has paid on the deductible
or coinsurance amount- Check 3 and write the
amount paid in Block 22.
Patient has Medicare primary and a secondary
plan which has denied the service, or applied the
coinsurance to deductible- Check 5 and attach
the secondary carrier’s Explanation of Benefits.
Title XVIII- Block 07
07 Primary Carrier Information Other Than
Medicare
2 No Other Coverage
3 Billed and Paid
5 Billed No Coverage
Title XVIII- Block 08
08
Type Of
Coverage
Medicare
B
Type Coverage MedicareMark type of coverage “B”.
Title XVIII- Block 17
17 Charges To Medicare
Block 17: Charges to Medicare- Enter the
total charges submitted to Medicare.
Title XVIII- Block 18
18 Allowed By Medicare
Block 18: Allowed by Medicare- Enter the
amount of the charges allowed by Medicare.
Title XVIII- Block 19
19 Paid By Medicare
Block 19: Paid by Medicare- Enter the
amount paid by Medicare (taken from the
EOB).
Title XVIII- Block 20
20 Deductible
Block 20: Deductible- Enter the amount of the
deductible (taken from the Medicare EOB).
Title XVIII- Block 21
21 Co-Insurance
Block 21: Coinsurance - Enter the amount of
the coinsurance (taken from the Medicare
EOB).
Title XVIII- Block 22
22 Paid By Carrier Other Than
Medicare
Block 22: Paid by Carrier Other Than MedicareEnter the payment received from the secondary
carrier (other than Medicare). If Code 3 is marked
in Block 7, enter an amount in this block.
(Do not include the Medicare payment.)
Title XVIII- Block 23
23 Patient Pay Amt. LTC Only
Block 23: Patient Pay Amount, LTC Only-
Leave Blank.
TITLE XVIII- Adjustment Invoice
DMAS-31
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Block 1
Adjustment/Void
Check the appropriate block
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Block 2
Billing Provider Number
Enter the NPI of the billing provider
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Block 6
Rendering Provider Number
Enter the NPI of the rendering provider
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Block 2A Reference Number
Enter the ICN number taken from the
Remittance Voucher for the line of payment need
adjustment.
TITLE XVIII- Adjustment Invoice
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Blocks 3-20
Refer to instructions for the DMAS-31 for the
completion of these blocks.
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Remarks
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This section of the invoice should be used to give a
brief explanation of the change needed.
Signature
Signature of the provider or agent and the date
signed.
THANK YOU
Department of Medical Assistance
Services
www.dmas.virginia.gov