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Showing posts from July, 2011

Birthday Rule

Its a method to determine which insurance will act as primary for a children either dad or mom, according to rule which person birthday comes first month and date that person insurance will be considered as primary, no need to consider year if both mom and dad’s birthday are falls on same date who is having insurance for longer time that person insurance will act as primary. this is called birth day rule.

Medicare Part A & B eligibility

Medicare Eligibility for Part B 1)       Permanent resident of United Status 2)       You or Your spouse worked in Medicare Covered employment and your 65 or 65 plus 3)       You might also eligible for Medicare before 65 but you should be disabled or End stage Renal Disease (ESRD / Permanent Kidney failure requiring dialysis or Transplant) 4)           Monthly Premium for part B in 2011 $ 115.40 which 4.5% more than the 2010 premium  Medicare Eligibility for Part A No Need to pay premium for part A in the following condition 1)       If you already getting retirement benefit from Social Security or Railroad Retirement Board 2)       If you are eligible for Social Security or Railroad benefit but not filed for them 3)       Either you or your spouse had Medicare covered government employment  Under age 65 1)       ESRD and Met certain requirement 2)       Already received Social Security or Railroad Retirement board disability benefit for 24

Medicare Non Covered HCPCS Codes

This Contain 5 Character HCPCS level II, Interim, and 3 Character HIPPA compliant revenue codes used for billing. but interim codes are not used to bill MCR, it included in assist provider in determining the type of services (ToS) not covered by MCR.   Codes Description When to Bill Medi-Cal Directly G0154, G0156, S5130, S5165, S5170, S9470, T2003, T2022, T2025, T2026, T2028, T2029 AIDS Waiver Always A0430, A0431, X0510 – X0522 Air Ambulance Any non-emergency TAR-authorized service A0800, A0999, X0002 – X0020, X0030 – X0036 Ambulance Any non-emergency TAR-authorized service X0200 – X0222, X0400 – X0416 Ambulance/Medical Transportation Always V5008, V5010, X4526 – X4528, X4532, X4542 Audiology Always X4500 – X4524, X4530, X4534 – X4540, X4544, X4546, Z0316 Audiology If for hearing aid