Medicare A and B billing

Mtee

Contributor
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Hillsboro, OR
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Hello, I am looking for references for what claims forms are billed to Part A and Part B.

I think it is that the UB-04 goes to Part A and the CMS-1500 form goes to Part B, but I would love any official reference to verify this.

I'm also looking for a list of what services are billed to Part A and what services are billed to Part B.

This is for an FQHC. I have searched online and read through the CMS Medicare FQHC resources, but I'm still having a hard time finding this information in black & white.


THANK YOU FOR YOUR HELP!!! I hope all of your days are going well.
 

thomas7331

True Blue
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This is an area where the terminology sometimes gets confusing because 'Part A' and 'Part B' are used interchangeably to talk about both benefits and the carriers that process claims for Medicare, but these are separate things, and I'm not sure which you're referring to here.

The claim form is actually going to be determined by the type of provider, not by which part of Medicare covers the service. Facilities bill on the UB-04 forms and professional providers bill on the CMS-1500 form. The UB-04 form will be billed to the carrier that many people will call 'Part A', but that's not quite correct because Part A is a benefit, which only covers inpatient facility says, blood transfusions, some home health care services, and a few other things. Since Part B covers outpatient facility services and physician services, an outpatient facility claim, for example, will be paid under Part B benefits, but it will be billed on a UB-04 form to the same carrier that processes the inpatient claims which are paid under Part A. So you would bill to the carrier that enrolls the particular provider you are billing for, and that carrier would instruct you as to what claim form they require your services to be submitted on, based on your provider type.

Does that help any, or just make it more confusing?
 

sls314

Networker
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Toledo, OH
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Yes, what Thomas said.

The claim form is determined by the provider type. For example, hospital outpatient services are billed on a UB-04 form and Medicare Part B pays the charges.

Think of the UB-04 as the institutional/facility claim form and the CMS-1500 as the professional claim form.
 

Mtee

Contributor
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Hillsboro, OR
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Have you tried looking at the Medicare Claims Processing Manual? This may help answer your questions.
These are the sources I've looked at and I'm still confused on it. Today I will post the specific parts I'm reading and maybe that will help? Thank you for your reply!
CMS Benefit manual
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c13.pdf
CMS Claims processing manual
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c09.pdf
Labs - FQHC sections in the chapter
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c16pdf.pdf
 

Mtee

Contributor
Messages
21
Location
Hillsboro, OR
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0
This is an area where the terminology sometimes gets confusing because 'Part A' and 'Part B' are used interchangeably to talk about both benefits and the carriers that process claims for Medicare, but these are separate things, and I'm not sure which you're referring to here.

The claim form is actually going to be determined by the type of provider, not by which part of Medicare covers the service. Facilities bill on the UB-04 forms and professional providers bill on the CMS-1500 form. The UB-04 form will be billed to the carrier that many people will call 'Part A', but that's not quite correct because Part A is a benefit, which only covers inpatient facility says, blood transfusions, some home health care services, and a few other things. Since Part B covers outpatient facility services and physician services, an outpatient facility claim, for example, will be paid under Part B benefits, but it will be billed on a UB-04 form to the same carrier that processes the inpatient claims which are paid under Part A. So you would bill to the carrier that enrolls the particular provider you are billing for, and that carrier would instruct you as to what claim form they require your services to be submitted on, based on your provider type.

Does that help any, or just make it more confusing?
Yes, it does help! I will need to ask more questions.

This is the request I'm working on: Provide a list of all codes that are split from Medicare A to Medicare B.

It's not clear to me if this request is regarding the benefit or carrier.
 
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