1 / 11

How Buy-In Works

How Buy-In Works. Automatic (If case is appropriately coded) : If client is receiving Medicare Part A when they apply. Contact Buy-in Unit: If client is eligible for but not receiving Medicare Part A. How Buy-In Works. Process - Client Eligible For OHP Plus:

jelani-rios
Download Presentation

How Buy-In Works

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. How Buy-In Works • Automatic (If case is appropriately coded): • If client is receiving Medicare Part A when they apply. • Contact Buy-in Unit: • If client is eligible for but not receiving Medicare Part A.

  2. How Buy-In Works • Process - Client Eligible For OHP Plus: • Code all current OHP Plus eligibility (Usually OSIPM). • Receives Part A (no cost)/Receives Part B: • Code Case. No additional action required. Note: Set Tickler for disabled OSIPM clients receiving SSDI (mostly SSDI/SSI combo cases or SSDI Service cases), but have not met the 2 year SSDI requirement.

  3. How Buy-In Works • Process - Client Eligible For OHP Plus (Cont.): • Receives Part A (no cost)/No Part B: • If eligible for QMB-BAS: • Code with MIB 2 (Medicare A & D in Health Ins. tab of ACCESS) & FS1 C/D; Note: No QMB Med Prg/#, No QMM C/D. • Wait for confirmation from Buy-in unit; • Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMM C/D.

  4. How Buy-In Works • Process - Client Eligible For OHP Plus (Cont.): • Receives Part A (no cost)/No Part B (Cont): • If eligible for SMB/SMF: • Code with MIB 2 (Medicare A & D in Health Ins. tab of ACCESS) & FS2 C/D; Note: No SMB/SMF Med Prg/#, No SMB/SMF C/D. • Wait for confirmation from Buy-in unit; • Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), SMB/SMF Med Prg/#, SMB/SMF C/D. • All other OHP Plus (SBI): • Code with MIB 2 (Medicare A & D in Health Ins. tab of ACCESS) & FS2 C/D; • Wait for confirmation from Buy-in unit; • Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), SBI C/D.

  5. How Buy-In Works • Process - Client Eligible For OHP Plus (Cont.): • No Part A/ Receives Part B: • If Otherwise eligible for QMB-BAS: • Code with MIB 1 (Medicare B & D in Health Ins. tab of ACCESS) & FS1 C/D; Note: No QMB Med Prg/#, No QMM C/D. • Contact Buy-in Unit for Part A, wait for response; • Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMM C/D. • All other OHP Plus (SBI): • Code with MIB 1 (Medicare B & D in Health Ins. tab of ACCESS), FS2 & SBI C/D.

  6. How Buy-In Works • Process - Client Eligible For OHP Plus (Cont.): • No Part A/No Part B • Complete DHS 1460B and give to client: • Client needs to take form to local SSA office to sign up for Medicare; • SSA will then contact Buy-In unit; • Once the Buy-In unit has set up for buy-in, and buy-in has processed, they will contact worker to code for QMB-BAS, QMB-SMB/SMF or SBI; Note: SSA normally contacts the buy-in unit very quickly (sometimes same day) when they receive a 1460B from our client. Staff should set Tickler for 2 weeks to follow-up with the Buy-In unit.

  7. How Buy-In Works • Process - Client Not Eligible For OHP Plus: • Receives Part A (no cost)/ Receives Part B. • Code Case. No additional action required.

  8. How Buy-In Works • Process - Client Not Eligible For OHP Plus (Cont.): • Receives Part A (no cost) / No Part B: • If Otherwise eligible for QMB-BAS: • Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMB C/D; • Set Tickler to confirm buy-in. • If Otherwise eligible for QMB-SMB/SMF: • Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), SMB/SMF Med Prg/#, SMB/SMF C/D; • Set Tickler to confirm buy-in.

  9. How Buy-In Works • Process - Client Not Eligible For OHP Plus (Cont.): • No Part A / Receives Part B: • If Otherwise eligible for QMB-BAS: • Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMB C/D. Open case effective 1st day of following month; • Contact Buy-in unit for Part A; • Set Tickler to confirm buy-in.

  10. How Buy-In Works • Process - Client Not Eligible For OHP Plus (Cont.): • No Part A / No Part B: • If Otherwise eligible for QMB-BAS: • Complete DHS 1460B and give to client; • Client needs to take form to local SSA office to sign up for Medicare Part B; • Set up pended case and narrate; • SSA will then Contact Buy-In unit; • Set Tickler to confirm Part B buy-in; • Once the Buy-In unit has set up for Part B buy-in, and it has processed, they will contact worker; • Once Part B buy-in confirmed proceed as “No Part A / Receives Part B” from previous slide.

  11. How Buy-In Works • Retroactive Buy-In (SMB/SMF): • For P2 clients only. • Determine eligibility month-by-month for retro. • Code as normal (can go back to first of previous month on CM). • Send 148 for remainder. • Contact Buy-In unit with retro dates.

More Related