When billing Medicare Replacement plans, the patient needs to meet the same homebound and skilled need as anyone on Traditional Medicare.
If the patient has a Dual Medicare/Medicaid plan, then billing will depend on the criteria the patient meets. If the patient meets Medicare criteria, then you will bill the Medicare portion of the Dual plan. In that case, I bill the same
way that I bill traditional Medicare, (except for Medica MSHO, for some reason they have us bill per month, but PDGM everything else, this might be different per agency).
If the patient has a Dual Medicare/Medicaid plan and they do not meet Medicare criteria, but have medical necessity, then we can bill the plan like we would for traditional Medicaid. We just use codes T1030 for RN and T1031 for LPN.
Our system is set up for these different billing scenarios.
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Allison Delwiche
Sent: Thursday, July 07, 2022 10:48 AM
To: Gretchen Salzwedel <GSalzwedel@regencyhhc.com>; billers@list.mnhomecare.org
Subject: RE: Billing question
|
**External Sender**
|
Hi,
Thank you for the guidance thus far. We are hoping to get further clarification on a few items:
- If I client is on a Medicare replacement plan, do you always bill their claims episodic (even if they are receiving ongoing, long term care)?
- We have typically used T1030 for SNVs, but are we able to further classify such as using T1001 for a nursing assessment?
Thanks,
Allison Delwiche
Regency Home HealthCare
651-488-4655 Office
651-488-4656 Fax
Confidentiality Notice: The information contained in this message may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message
to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to the message and deleting
it from your computer. Thank you.
From: Gretchen Salzwedel <GSalzwedel@regencyhhc.com>
Sent: Thursday, July 7, 2022 9:40 AM
To: Allison Delwiche <ADelwiche@regencyhhc.com>
Subject: FW: Billing question
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Salin, Tracy M
Sent: Thursday, July 7, 2022 8:55 AM
To: billers@list.mnhomecare.org
Subject: RE: Billing question
There isn’t really anywhere unless you want to pay for a billing and coding course for your billers. Most of us are self taught and with the help of MN Home Care Association we are all here to help.
The only payers who do episodic are Medicare, some medicare replacement plans, and VA. All MA and MA replacements plans and private plans bill per visit.
For billing, you want to ask this of the payer on referrals: What does the patient have for insurance? If Medicare or MA is it traditional or replacement plan? Does referral meet payer requirements? Does plan require authorization and if
so for which services? Does plan have OOP and Deductible?
Setting up the payer correctly on admit will set the tone for successful billing.
Next you will want to read up on MN DHS billing and Medicare billing. Private plans mostly follow Medicare coverage and coding requirements.
It is best to follow past billing in your EMR to see which payers use which codes. Some use Rev codes ending in a 1 with t codes and some use rec code ending in 0 using t codes. Likewise with G codes which are the medicare codes. Looking
at old remits is also a good source for how to bill to different payers as far a rev and hcpc codes.
Otherwise, please have your billing staff reach out to us here.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Gretchen Salzwedel
Sent: Thursday, July 7, 2022 8:41 AM
To: billers@list.mnhomecare.org
Subject: RE: Billing question
|
|
I have two questions:
1.
Is there anywhere for some good training on homecare billing? Not just Medicare but training on insurance billing as well. There is confusion on when to bill episodic vs fee-for-service for insurances.
2.
Do people use other billing codes either instead of nursing visits or in conjunction with? Some examples being: 99601 (Home infusion) or some of the nursing assessment codes.
Thank you!
Gretchen Salzwedel RN
Administrator
Regency Home HealthCare
651-707-5455 Cell
651-488-4655 Office
651-488-4656 Fax
Confidentiality Notice: The information contained in this message may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message
to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to the message and deleting
it from your computer. Thank you.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Hanson,April
Sent: Wednesday, July 6, 2022 6:57 AM
To: billers@list.mnhomecare.org
Subject: Re: Billing question
Thank you Marnie!
April Hanson
Patient Accounts
Perham Living
Ph: 218.347.1894
F: 218.347.1885
Dedicated to health and wellness throughout life.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Marnie Pogreba <marniepogreba@lakewoodhealthsystem.com>
Sent: Friday, July 1, 2022 11:51 AM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Cc: Flatau,Jennifer <Jennifer.Flatau@PerhamHealth.org>
Subject: [EXTERNAL] RE: Billing question
Hello April,
When a patient has both VA and Medicare, I believe it is the patient’s choice as to which plan they want to bill through. So, even though this patient has a skilled need for home care, but because he insisted
on billing the VA, that is allowable. I know it would be better to bill Medicare.
Medicare does allow Home Care while a patient is in Hospice, as long as home care is in there for services that are unrelated to the patient’s hospice care. You would bill Home Care with a condition code 07, including
the NOA.
In the case you shared, my thought is that you would be fine to bill home care under the VA as long as it is not related to his Hospice stay under Medicare. If the patient was willing to have his unrelated home
care billed under Medicare that should be ok too.
Marnie
BTW – I have this NGS News Alert from last year, this is all I have on the subject of billing for home care and hospice at the same time under Medicare.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Hanson,April
Sent: Friday, July 01, 2022 11:27 AM
To: billers@list.mnhomecare.org
Cc: Flatau,Jennifer <Jennifer.Flatau@PerhamHealth.org>
Subject: Billing question
|
**External Sender**
|
Good morning,
We have a patient on their VA benefit through home care for wound care. The patient's family asked that they be admitted under their VA benefit. Hospice is now involved
and they are billing Medicare. The patient would like to continue receiving home care services for their wound care. But being they are meeting a skilled need I really feel that they should have been admitted under Medicare. And home care and hospice couldn't
both be billing Medicare. What is the right thing to do in this scenario? Could the patient stay on home care under their VA benefit like the family is requesting while receiving hospice care under Medicare? Thanks!
April Hanson
Patient Accounts
Ph: 218.347.1894
F: 218.347.1885
Dedicated to health and wellness throughout life.
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