Medicare Advantage informational claims now due
Contemporary Long-Term Care Weekly, January 24, 2008
Effective January 1, skilled nursing facilities are now required to submit information-only claims to traditional fee-for-service fiscal intermidaries and Medicare Administrative Contractors in order to track and update Part A benefit periods for Medicare Advantage (MA) beneficiaries. (The premise is that, in terms of the benefit period, MA days are treated the same as Part A days.)
One forum caller understood to submit these as covered claims with the condition code "04" as explained in Transmittal 1290. However, she wasn't sure how to enter these claims into her billing software, asking, for example, whether the MA plan would be listed as the primary payer.
The MA plan doesn't need to be coded on the claim at all, suggested agency officials. "Just submit Medicare as primary. The '04' means that nothing is going to happen on that claim. There is going to be no reimbursement."
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