MDS Alert
What Do You Think? To Bill or Not to Bill Medicare Fee-For-Service for Medicare Advantage Patients
Published on Tue Apr 27, 2010 
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Question: If a resident is receiving skilled care covered by his Medicare Advantage plan, does the SNF need to send bills to its FI or MAC? Answer: "If a SNF resident is receiving skilled care covered by the Medicare Advantage plan, the SNF is supposed to submit monthly bills to the MAC or FI with a condition code of 04 that indicates the claim is for information only," says consultant Jennifer Wormington. The MAC or FI then uses the claim to update the Common Working File. SNFs are required to submit the claims to Medicare because "Medicare and the MA plans don't have systems set up to communicate" that information, adds Wormington, with BKD LLP in Springfield, Mo.
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