Medicare TrainingBy FBC Services

Medicare General Information Medicare A General Information

◦ NO-Pay and Benefit Exhaust Bills◦ SNF Denial Information◦ MSP Medicare Secondary Payer◦ Assessments and OMRA’s

Medicare B General Information◦ What’s Covered◦ Bundling and Therapy Caps◦ 59 and KX codes

Training Outline

DDE Information◦ Claims Correction◦ CWF

Roster Billing Questions and Answers

Training Outline Cont’d

The Medicare Program Eligibility Benefit Period

Medicare Overview

No Pay and Benefit Exhaust Bills SNF Denial Information MSP Medicare Secondary Payer Assessments and OMRA’s

Medicare A Overview

How and When to do a No-Pay Bill Appropriate Codes No-Pay Bill Vs. Demand Bills

No-Pay and Benefit Exhaust Bills

Denial on Admission UR Denials Denial Paragraphs For CMS Denial Letters Go To The CMS site

at

http://www.cms.hhs.gov/BNI/04_FFSSNFABNandSNFDenialLetters.asp

SNF Denial Information

MSP Overview When and How to Submit an MSP Claim

Medicare Secondary Payer (MSP)

ARD’s and Grace Days OMRA’s Assessment Schedule Assessment Tracker

Assessments and OMRA’s

MedicareMDS Assessment Type

Reason for Assessment (AA8b code)

Assessment Reference Date

Applicable Medicare Payment Days

5 day 01 Days 1 – 5 1 through 14

14 day 07 Days 11 – 14 15 through 30

30 day 02 Days 21 – 29 31 through 60

60 day 03 Days 50 – 59 61 through 90

90 day 04 Days 80 – 89 91 through 100

Medicare Assessment Schedule

What’s Covered To Bundle or Not to Bundle Therapy Caps 59 and KX codes What to do when you’re out of space

Medicare B General Information

F2, F10 and F6

F10 and F6

DDE Information Menu’s Claims Corrections and Adjustments CWF Roster Billing

Main Menu

Inquiry Menu’s

Claims-Special OC Codes Return to History Rejected Claims Claim Change Codes

Claims, Corrections and Adj

How to Read the CWF Insurance Codes

(CWF) Common Working File

CWF (Insurance codes)

FLU and PPV HCPCS Rates Format

Roster Billing

Roster Bill

Questions and Answers

GOOD BYE