Thank you!!

 

 

You have to verify with the plan when you see “Medicare Advantage” because sometimes the plan is primary for part A service, and sometimes Traditional Medicare is primary for part A. So if you are providing part A service, you would call the managed care plan and ask them whether you bill them as primary for part A Medicare claims, or whether you bill Medicare directly. We have to call on each of these, the Medicare phone system has changed and no longer gives a clear answer on this.

 

From what I understand, the MSHO plans generally coordinate the benefits for Medicare, but the MSC+ plans allow direct Medicare billing. Those are two of the dual solutions type plans when Clients also have MA coverage. Otherwise when the Client does not have MA, my understanding is that Medica does not offer a true Medicare replacement for part A, so I’ve seen Medica usually being cost sharing and we bill direct to Medicare on those plans. But BCBS and UCare do have true replacement plan options, so you have to verify each time.

 

 

 

I bill for home care services and I have a few questions:

 

There has been a lot of clients effective 01/01/2015 who have a Medicare advantage plan such as Blue cross. Who do you bill? When I have called Blue cross on some of these people they have told me that you must bill Medicare primarily.

 

I am also wondering what # oasis to be using for Medica MSHO or Blue Cross MSHO when the client is not on their Medicare level but receives either nursing services or nonskilled services such as Home Health Aid visits. I am also wonderinf what oasis to use for UCare Medicaid plans. Currently we have been using #4 oasis (Medicaid HMO/managed care), but we have recently been told by another Home care that they use #3 (Medicaid traditional fee-for-service)

 

Any help would be very much appreciated. Thank you!

 

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