Monday, April 4, 2011

DIRCECT FILING OF MCR HMO-HOSPICE CLAIMS TO MEDICARE

DESCRIPTION OF THE ISSUE
Medicare HMO Hospice Claims were billed incorrectly to the HMO plans directly.  We are suppose to bill the claims to Medicare.  Hence the claims were denied as “Bill Medicare Directly”

CONCEPT
Per 2010 Hospice Regulatory “The hospice, not the HMO, is responsible for managing the patient's hospice plan of care across all levels and sites of care. The Medicare-certified hospice bills Medicare, not the HMO, for the Medicare patient's hospice care”

SOLUTION
On receiving denials we analyzed 2010 Hospice Regulatory Act and started refiling denied claims towards Medicare directly. 

No comments:

Post a Comment

Popular Posts