UB-04 Medicare Exhaust Claims

1. UB-04 Medicare Exhaust Claims HP Provider Relations October 2011

2. 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

3. 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

4. Learn Medicare Exhaust Claims

5. 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

6. 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

7. Bill Electronic Exhaust Claims

8. 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

9. Billing Information

10. Coordination of Benefits

11. Coordination of Benefits

12. Billing Information

13. Attachment Information

14. Claims Attachment Cover Sheet Information entered must match the claim exactly

15. Bill Paper Exhaust Claims

16. Paper Billing Locators 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

17. Paper Billing Locator 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

18. Paper Claim Billing/Benefits Exhausted

19. Benefits Exhausted

20. Benefits Exhausted ACN # 1234567 Benefits Exhausted Member 111222333999

21. 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

22. Deny Common Denials

23. 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

24. 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

25. Find Help Resources Available

26. Helpful Tools Avenues 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 7263Indianapolis, IN 46207-7263 Provider Relations field consultant

27. Q&A