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Tag Archives: Advantage
Combing patient records for additional diagnosis codes reaps massive returns for Medicare Advantage plans
How do you bill a Medicare Advantage plan for Medicaid coinsurance?
We have recently gotten this denial from Medicaid for patients who have a Medicare Advantage plan and Medicaid secondary. 01153 CLIENT IS ENROLLED IN A MEDICARE ADVANTAGE PLAN (MAP). PROVIDER SHOULD CONTACT MAP FOR CO-PAYMENTS, CO-INSURANCE AND/OR
DEDUCTIBLES LIABILITIES. Does anyone know how you would go about billing the MAP for it? I have looked online and cannot find anything.
DEDUCTIBLES LIABILITIES. Does anyone know how you would go about billing the MAP for it? I have looked online and cannot find anything.
FQHC Billing Lab Services to Medicare Advantage plans
Hi,
I work for an FQHC in Hawaii and we are having issues with billing PPD tests and other lab services to Medicare Advantage plans like UHC, WellCare, etc.
Is there anyone else billing/coding for FQHCs who can share how they are billing labs to Medicare plans?
Laboratory services – Although RHCs and FQHCs are required to furnish certain laboratory services (for RHCs see section 1861(aa)(2)(G) of the Act, and for FQHCs see section 330(b)(1)(A)(i)(II) of the PHS Act), laboratory services are not within the scope of the RHC or FQHC benefit. When clinics and centers separately bill laboratory services, the cost of associated space, equipment, supplies, facility overhead and personnel for these services must be adjusted out of the RHC or FQHC cost report. This does not include venipuncture, which is included in the AIR when furnished in an RHC by an RHC practitioner or furnished incident to an RHC service, and it is included in the per-diem payment when furnished in an FQHC by an FQHC practitioner or furnished incident to an FQHC service.
I work for an FQHC in Hawaii and we are having issues with billing PPD tests and other lab services to Medicare Advantage plans like UHC, WellCare, etc.
Is there anyone else billing/coding for FQHCs who can share how they are billing labs to Medicare plans?
According to the Medicare FQHC Policy Manual under the subcategory Description of Non RHC/FQHC Services regarding lab services:
Quote:
Laboratory services – Although RHCs and FQHCs are required to furnish certain laboratory services (for RHCs see section 1861(aa)(2)(G) of the Act, and for FQHCs see section 330(b)(1)(A)(i)(II) of the PHS Act), laboratory services are not within the scope of the RHC or FQHC benefit. When clinics and centers separately bill laboratory services, the cost of associated space, equipment, supplies, facility overhead and personnel for these services must be adjusted out of the RHC or FQHC cost report. This does not include venipuncture, which is included in the AIR when furnished in an RHC by an RHC practitioner or furnished incident to an RHC service, and it is included in the per-diem payment when furnished in an FQHC by an FQHC practitioner or furnished incident to an FQHC service.
Does this mean that we should be billing for labs on a CMS-1500 under the rendering provider’s NPI instead of on a UB-04 under our FQHC’s NPI since they are not FQHC services, and expect to get separate reimbursement? We have the billing staff insisting that all of our UnitedHealthcare should be billed out on UB-04 forms regardless of the services we are billing for.
Any assistance is greatly appreciated!
LAAC clinical registry Med Advantage Member
We are getting mixed responses on who should be billed for the facility charges for a LAAC clinical registry claim. Is Traditional Medicare or Med Advantage responsible? Thanks for any help you can provide.
Denials from advantage plans on defibrillator code 33249
Hi there Coders 
I am needing your help figuring out why Advantage plans are denying 33249 saying not a covered Dx (Cardiomyopathy), but is covered through Medicare and is on the NCD.
If anyone knows the answer it would be greatly appreciated.
Thank you
Rhonda S.,CPC
I am needing your help figuring out why Advantage plans are denying 33249 saying not a covered Dx (Cardiomyopathy), but is covered through Medicare and is on the NCD.
If anyone knows the answer it would be greatly appreciated.
Thank you
Rhonda S.,CPC
CMS raises Medicare Advantage pay rates by 3.4% for 2019
Medicare/Medicaid Advantage Incentive Programs
I am in a unique position at RHN. I am in charge of Medicare/Medicaid Advantage Plans bonus incentive plans. I am looking to network with others who working with these programs. Is there anyone out there????
CMS proposes Medicare Advantage and Part D payment and policy updates
How to Take Advantage of a Medical Alert Bracelet If You Have Asthma
Wearing a medical alert bracelet can save your life if you have Asthma. More and more people are diagnosed with Asthma today. Where and when you will have an attack remains a mystery and why you are having it is even a bigger mystery. No Asthma knows for sure what will set off an attack, or when it may occur. When an attack occurs it is very frightening for those around you, especially if they do not know what is happening. If you are wearing an alert bracelet they will know what is happening and how to help you. In this article I would like to give you some tips on what information your emergency alert bracelet should contain.
First, choose the bracelet style you like. There are many companies out there that make many different styles and shapes. When selecting one make sure you choose one that will work for you. You want one that is attractive to you but at the same time it can display necessary information.
Second, you want to make sure the information you put on your bracelet is concise but at the same time it is viable. You want to make sure the reader will know what to do with the information they get from your bracelet. Make sure the engraving is legible on the bracelet.
Third, if you are listing your medications on the bracelet make sure you have the correct spelling of the medication and the correct dosage.
Fourth, if there is any possibility that you may not be able to speak or even pass out. You may want to put your name and the phone number of who to call. An emergency contact could help health care professionals greatly.
Lastly, the peace of mind for you and your love ones that the bracelet will afford you and your love ones is well worth the inconvenience and embarrassment of wearing a bracelet.
Get Free: Easy Asthma Remedies