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Medicare HMO Billing HELP

  1. #1
    Unhappy Medicare HMO Billing HELP
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    Ok this is a question for you Billing Folks out there. I'm clueless !!!

    The Billing Folks here want to know , How to Bill Medicare HMO.
    Should they Bill them just like Medicare?
    or do they Bill them like Regulare Insurance.

    Help !!!!!! I'm totaly Lost on this, I've never done any of the Billing side ,
    I've only done Coding Auditingr with no billing side !


  2. Post Billing HMO's
    I work in a Facility setting and we treat our HMO claims the same way we bill Medicare. Also don't forget if you are billing as a facility and have any inpatient claims for patients with HMO's they need to be reported to Medicare for tracking purposes. At least we do at our facility. If anyone knows that need to be to the contrary I would be interested in knowing.

  3. #3
    True! if you have a Medicare HMO plan you need to bill that HMO plan just like if you were billing regular insurance. Also if it is a medicare hmo inpatient claim you do need to send medicare a no pay clam "type of bill 110" for tracking purposes, this is after your claim pay with the HMO.

  4. Default Medicare HMO
    First, be sure you are contracted with the HMO. Most HMO's don't pay out of network claims.
    Next, ask for their list of covered services. Also, many HMO's publish their clinical guidelines and these will give you clues to what's covered, for what diagnoses and how often. HMO's sometimes use Medicare guidelines, but often create their own which can be a real headache to figure out.
    If they have a website, check it out. You may find many resources there.
    Find out who their local provider relations rep is and request a visit.
    Be sure to document everyone you speak to with their title and phone number. You never know when you might need to call a medical director. Medical directors are involved in developing policies and procedures and can be very influential in getting problems addressed.

  5. #5
    Smile Medicare hmo
    Medical Billing
    I work for a billing company who bills for physicians only. We also treat medicare hmo's as a reg ins and mark the acct MDCRHMO so when the payments come in, we know to adjust the medicare nonallowed amt. Question, since we are only billing for physicians, are we also supposed to be sending a no pay claim to medicare when we receive payment. Honestly, I never heard of that. Please advise.

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