HP Provider Relations October 2011 UB-04 Medicare Exhaust Claims

HP Provider Relations

October 2011

UB-04 Medicare

Exhaust Claims

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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

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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

LearnMedicare Exhaust Claims

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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

BillElectronic Exhaust Claims

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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

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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 SheetInformation entered must match the claim exactly

BillPaper Exhaust Claims

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Paper BillingLocators 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

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Paper BillingLocator 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

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Paper Claim Billing/Benefits Exhausted

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Benefits Exhausted

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Benefits Exhausted

ACN # 1234567

Benefits ExhaustedMember 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

DenyCommon Denials

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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

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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

Find HelpResources Available

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Helpful ToolsAvenues 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

Q&A