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Frequently asked questions

Billing and claims

• How do I bill Medicare Plus Blue PFFS^SM?
• What will I be reimbursed?
• May I bill a member for noncovered services?

Cost sharing

• Evaluation and management services (PDF)

Eligibility

• How do I know if this patient is eligible?
• Where can I verify coverage?

Forum presentations and follow-up

• Facility forum on Aug. 21, 2008 (PDF)
• Facility forum on Dec. 9, 2008 (PDF)
• Home health care forum on Oct. 23, 2008 (PDF)
• Home health care forum Q & A on Oct. 23, 2008 (PDF)

Home health care

• If a member's Medicare coverage changes at the end of a calendar year during a home health episode of care, how should the agency bill for the episode?
  

  If a patient had Original Medicare coverage when the home health care episode began and then enrolled in Medicare Plus Blue PFFS before the episode ended, take the following steps:

  • Submit a claim to the regional home health and hospice intermediary to close the episode.
  • Complete a new Outcome and Assessment Information Set (OASIS).
  • Submit a Request for anticipated payment based on the new OASIS to Medicare Plus Blue PFFS to open a new episode.

  If a patient had Medicare Plus Blue PFFS coverage when the home health care episode began and then enrolled in Original Medicare before the episode ended, take the following steps:

  • Submit a claim to Medicare Plus Blue PFFS to close the episode.
  • Complete a new OASIS and submit it to the state.
  • Submit a Request for anticipated payment based on the new OASIS to the regional home health and hospice intermediary to open a new episode.

• Four different scenarios if the member's coverage changes during an episode (PDF)

Medical record reviews

• Do you have questions about MedAssurant reviews? (PDF)

Medicare Plus Blue PFFS

• What are the terms and conditions?
• What is a private fee-for-service plan?
• What is the "deeming" process?
• What do people on Medicare need to know about group private fee-for-service plans? (PDF)
• What do people on Medicare need to know about individual private fee-for-service plans? (PDF)
• Who can I contact for more information?
• Information for all health care providers (PDF)
• What if I don't participate with Medicare?

Other Blue plans

• Which other Blue plans offer Medicare Advantage coverage? (PDF)

Pharmacists

• Questions frequently asked by pharmacists (PDF)