IN-PATIENT SERVICES

 Independent RHC In-Patient services are billed to Medicare Part B on a 1500 claim form 

 Provider Based RHC In-Patient services are billed under the Main Provider on UB format. 

 Some MACs will cover the In-Patient claim AND an office encounter on the same date. Know your MAC and what their payment guidelines are for this component. 

 EXAMPLE: If your MAC will cover both you may have the following example.

 Office visit and inclusive services billed to Medicare Part A on UB format 

 In-Patient services billed to Medicare Part B on 1500 format.

NURSING HOME SERVICES

Nursing home services (including SNF) are billed to Medicare Part A on a UB form.

MEDICARE COPAYS/DEDUCTIBLES

 The effect on payment is an increase in the charge, and in the co-insurance. 

 RHC services deductible is based on billed charges. Non-covered expenses do not count toward the deductible. 

 The cost for incident-to-services are included in the cost report, but they are not payable on the claims. EXAMPLE: The patient has an office visit for $65.00 and an injection for $40.00. There will be one line item of $105.00 on the UB form with revenue code of 521. The patient (or secondary) will be responsible for $21.00 which is the 20% co-insurance

MULTIPLE BILLING OPTIONS

 On rare occasions the clinic may be able to bill for two encounters on the same day to Medicare Part A. 

 Example: If the patient comes to the clinic in the morning and is treated with bronchitis and then returns to the clinic in the afternoon with a wrist injury. Each would be considered their own encounter and they can be billed separately on their own claim forms. One will probably be rejected, but an appeal with notes attached will assist the office for payment consideration. 

 The clinic can bill Medicare Part A and Workers Comp or Auto for services rendered on the same day. 

 Example: Patient presents for knee injury from an auto or workers comp accident and they also have developed bronchitis. The provider can write TWO clinics notes with each note specifying the details of the visit for each and the knee can be billed to the workers comp or auto and the bronchitis will be billed to the Medicare Part A.