October 2009

Billing Medicare Part A Benefit Exhaust ClaimsPresented by

EDS Provider Field Consultants

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Agenda

•Objectives•What is a Medicare Benefit Exhaust Claim•Billing Part B Charges•Billing Electronically•Paper Billing Locators 50 through 54•Paper Billing Locator 39•Supporting Documentation•Common Denials•Helpful Tools•Questions

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Objectives

At the end of this session, providers will understand:

•What constitutes a Medicare Benefit 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

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What Constitutes a Medicare Exhaust Claim

•Dually eligible member (Medicare and Medicaid coverage)

• 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

•Part B charges must be billed to Medicare before billing the exhaust inpatient claim to IHCP

– Include Part B charges on the Part A Medicare claim

•Medicare Part B claims automatically crossover

•Must void the Medicare B crossover claim

– Inpatient claim will deny as a duplicate claim if Part B claim is not voided

•Must enter the Part B Medicare payment as a third-party liability (TPL) payment

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•Medicare Benefit Exhaust claims may be submitted electronically via Web interChange using the Attachment feature

•“Benefits Exhausted” must be typed in the Notes field of the claim submission screen

•The supporting documentation required for the electronic claim is the same as for the paper claim

Billing Electronically

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Billing Information

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Claim Note Information

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Attachment Information

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Benefits Exhausted

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Claims Attachment Cover Sheet

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Coordination of Benefits

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•Demonstrate the fields of input for an Exhaust claim

•Demonstrate the attachment control number (ACN) process

•Demonstrate the Notes process

Electronic Billing Demonstration

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• Providers must verify member eligibility to determine if the patient is enrolled in Traditional Medicaid including Care Select

• These claims are billed on the UB-04 claim form

• Part B payments are indicated by entering the word, “Exhaust” in locator 50 on lines a or b

– Do not enter the word “Medicare” on the claim

• The payment is entered in field 54

• Commercial payments are entered in the same manner

• Use line c in fields 50 through 55 for the Medicaid billing

Paper BillingLocators 50 through 55

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•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 TPL claims

•All other UB-04 billing policies apply

Locator 39

Paper Billing

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DRAFT

Paper Billing

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Benefits Exhausted

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Benefits Exhausted

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• In the top or bottom margin of the UB-04 claim form boldly write the words:

– “Benefits Exhausted”

•On the top of the MRN or FSS screen print boldly print:

– “Benefits Exhausted”

– IHCP Member ID number

•The information on the supporting documentation must match the information presented for Medicaid claim

•Claims are Medicaid primary; all filing limit and prior authorization rules apply to these claims

Support Documentation

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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, b, or c

•Resolution – Remove the word “Medicare” from field 50

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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 or bottom margin of the UB-04 claim form. Type the words “Benefits Exhausted” in the “Notes” section of the electronic bill.

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• IHCP Web site at www.indianamedicaid.com

• IHCP Provider Manual (Web, CD-ROM, or paper)

•Customer Assistance– Local (317) 655-3240

– All others 1-800-577-1278

•Written Correspondence– EDS Provider Written Correspondence

– P. O. Box 7263

– Indianapolis, IN 46207-7263

•Provider field consultant

Avenues of ResolutionHelpful Tools

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Questions

October 2009

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