HOW TO BILL AN INPATIENT CLAIM
WHEN A PATIENT HAS MEDICARE
PART B AND MEDICAID
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ALL PATIENTS WITH MEDICARE
PART B ONLY AND MEDICAID MUST
BE PRECERTED WITH MEDICAID!!!
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Bill Part B as bill type 121
Bill Ancillary Charges to
Medicare
The next few slides will show
you what to bill to Medicare for
Part B payments.
These were copied off the
Medicare Hospital Billing
Manual.
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Services payable by Medicare Part B are:
• Diagnostic x-ray tests, diagnostic laboratory tests, and other
diagnostic tests;
• X-ray, radium, and radioactive isotope therapy, including
materials and services of technicians;
• Surgical dressings, and splints, casts, and other devices used
for reduction of fractures and dislocations;
• Prosthetic devices (other than dental) which replace all or part
of an internal body organ (including contiguous tissue), or all or
part of the function of a permanently inoperative or
malfunctioning internal body organ, including replacement or
repairs of such devices;
• Leg, arm, back, and neck braces, trusses, and artificial legs,
arms, and eyes including adjustments, repairs, and
replacements required because of breakage, wear, loss, or a
change in the patient’s physical condition;
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Covered Part B Services Continued….
• Outpatient physical therapy, outpatient speechlanguage pathology services, and outpatient
occupational therapy (see the Medicare Benefit
Policy Manual, Chapter 15, “Covered Medical and
Other Health Services,” §§220 and 230);
• Screening mammography services;
• Screening pap smears;
• Influenza, pneumococcal pneumonia, and
hepatitis B vaccines;
• Colorectal screening;
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Covered Part B Services Continued….
• Bone mass measurements;
• Diabetes self-management;
• Prostate screening;
• Ambulance services;
• Hemophilia clotting factors for hemophilia patients
competent to use these factors without supervision);
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Covered Part B Services Continued….
• Immunosuppressive drugs;
• Oral anti-cancer drugs;
• Oral drug prescribed for use as an acute
anti-emetic used as part of an anti-cancer
chemotherapeutic regimen; and
• Epoetin Alfa (EPO).
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After Medicare Part B pays on these
services Medicaid should pay on
the cross over claim.
If no payment received within 45
days, you may manually key the
cross over claim into the web
portal for payment.
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Medicare and Medicaid pays the
Ancillaries on the 121 bill
type…WHAT TO DO NEXT?
File Medicaid NOW on a 111 bill type
for the “rest”
“REST” is:
Accommodations
Pharmacy
Observation
ER
OR
Any services not listed on the
Part B slides.
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This claim HAS to be sent in
HARDCOPY with:
Copies of the ORIGINAL 121
UB04 sent to Medicare
with the EOB’s from Medicare
and Medicaid.
Has to be on the red and
white form.
This claim CANNOT be hand keyed
or edited on the WEBPORTAL
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Bill classification111 should be
used.
Enter “Medicare Part B” the Primary
payer on Line A of Form Locator
50.
Enter the amount paid by Medicare
and Medicaid under Part B as a
prior payment in Form Locator 54.
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MAIL CLAIM TO:
DEPARTMENT OF COMMUNITY HEALTH
Third Party Liability Unit
2 Peachtree Street, NW 39th Floor
Atlanta, GA 30303-3159
Mail Certified with RETURN RECEIPT REQUESTED.
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For some reason, most of these
claims have to be sent several
times.
You can see the claims on the web
portal but cannot access them.
Wait at least 45 days before
“resending” the claims again.
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