Question
QUESTION: If a beneficiary cancels a Medicare Advantage plan and failed to notify us of this (assumes that Medicare Traditional coverage automatically takes over), without the Start of Care visit we could not generate the necessary Medicare claims for the visits following this unknown policy cancellation. For the non-covered visits following the cancellation of the Medicare Advantage policy, does Medicare policy allow for the billing of these visits directly to the patient? Is the beneficiary allowed to submit these visit charges to Medicare?
ANSWER: Hi Randall
Was COB notified of the change?
Was a claim sent to Medicare and denied?
John
---------- FOLLOW-UP ----------
QUESTION: Yes COB was notified by the beneficiary's POA. We can not generate the Medicare claim because a Start of Care OASIS visit must be performed to initiate the start of the Medicare Traditional Episode for the beneficiary and since we were not notified of the cancellation this assessment was not performed to develope the HIPPS and HHRG score required for filing the home health claim.
Answer
Hi again
A bit out of my area of expertise. We do not get into the day by day procedure for filing claims. There should be no problem with the claims filed for service received before the Advantage plan was cancelled. For service after that, either the provider or the patient should file a claim with Medicare which would be processed under original Medicare leaving patient responsible for deductible and the 20%. This is about as far as we go on claim processing, More complete information can be found in the Medicare Providers Manual.
John
