Author Topic: Who pays  (Read 1750 times)

Tsaav

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Who pays
« on: February 08, 2010, 01:35:18 PM »
Hi everyone.

I have an issue with a claim. The insurance company, United Healthcare, want me to refund back a claim. The claim is for T1019 personal care, which should be paid for by Medicaid. And one of their rep said it should be paid. Told me to let them know when they denied a claim to look in their handbook. The patient does have medicare, but the rep said medicaid pays for personal care. Is this the correct information? I tried to look for their policy online but haven't found where it is.

Thanks,

Tsaav

Pay_My_Claims

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Re: Who pays
« Reply #1 on: February 08, 2010, 03:59:08 PM »
if non-covered by Medicare, and from what I know that isn't you can bill medicaid directly

Michele

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Re: Who pays
« Reply #2 on: February 09, 2010, 07:11:54 AM »
I do not believe that is covered by Medicare.  If Medicaid does cover it they should be billed directly.

Michele
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Tsaav

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Re: Who pays
« Reply #3 on: February 09, 2010, 02:52:15 PM »
Well, the issue is that this is a non-skilled long term care with PA. UHC is the HMO of choice for the patient for their medicaid coverage. UHC should be paying, correct?

Pay_My_Claims

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Re: Who pays
« Reply #4 on: February 09, 2010, 09:39:20 PM »
Well, the issue is that this is a non-skilled long term care with PA. UHC is the HMO of choice for the patient for their medicaid coverage. UHC should be paying, correct?

medicare hmo's follow the same guidelines as medicare. most of them do not cover what Medicare will not.

Michele

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Re: Who pays
« Reply #5 on: February 10, 2010, 08:32:25 AM »
It's a Medicaid HMO, not Medicare right?  So it's going to go by the state's Medicaid laws.  You may have to contact your states department of health to get an answer.

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Tsaav

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Re: Who pays
« Reply #6 on: February 10, 2010, 02:18:25 PM »
Thanks. Home care or personal care is what I bill for and the state does pay. So UHC should pay for the service. Here are some information that you ladys may find helpful. I don't think you guy deal home care billing much. But everyone here is alway helpful. Thanks.

http://www.medicare.gov/longtermcare/static/home.asp

http://assets.opencrs.com/rpts/RL33919_20070315.pdf

http://assets.opencrs.com/rpts/RL33357_20060411.pdf

Pay_My_Claims

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Re: Who pays
« Reply #7 on: February 10, 2010, 03:50:53 PM »
Did you READ the articles you presented??? There is a difference between long term care and personal care services. This means while Medicare will pay for me to be in a skilled facility, they won't pay for someone to perform daily living activities.  I worked with residents in those facilities, and certain services are paid for by Medicare, while others are billed directly to medicaid.


Medicare and Long-Term Care:

While there are a variety of ways to pay for long-term care, it is important to think ahead about how you will fund the care you get. Generally, Medicare doesn’t pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn’t pay for this type of care called "custodial care". Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring. Some Medicare Advantage Plans (formerly Medicare + Choice) may offer limited skilled nursing facility and home care (skilled care) coverage if the care is medically necessary. You may have to pay some of the costs. For more information about Medicare Advantage Plans, look at the Medicare Personal Plan Finder.