Podcast
Questions and Answers
CVS does not currently bill Medicare Part B for which of the following?
CVS does not currently bill Medicare Part B for which of the following?
- Continuous glucose monitors
- Nebulizers
- Both A and B (correct)
- None of the above
Medicare Part B claims are adjudicated in a/an _____ manner.
Medicare Part B claims are adjudicated in a/an _____ manner.
non-real time
Beneficiaries are responsible for what percentage of prescription costs after their yearly deductible has been met?
Beneficiaries are responsible for what percentage of prescription costs after their yearly deductible has been met?
20%
When is a supplier standards form required to be provided to the beneficiary?
When is a supplier standards form required to be provided to the beneficiary?
AOB forms must be collected every time a beneficiary fills a Medicare Part B prescription at any CVS location.
AOB forms must be collected every time a beneficiary fills a Medicare Part B prescription at any CVS location.
Failure to report the correct insulin dependence indication may be considered waste under Medicare's fraud regulations.
Failure to report the correct insulin dependence indication may be considered waste under Medicare's fraud regulations.
If the group ID of TPPC 22345 is populated with a state abbreviation and Medicaid ID, this will result in a claim being auto-crossed.
If the group ID of TPPC 22345 is populated with a state abbreviation and Medicaid ID, this will result in a claim being auto-crossed.
Beneficiary owned equipment information prompts must be completed to remain compliant with Medicare Part B billing guidelines.
Beneficiary owned equipment information prompts must be completed to remain compliant with Medicare Part B billing guidelines.
What is the purpose of the assignment of benefits form?
What is the purpose of the assignment of benefits form?
Medicare standard utilization guidelines for diabetic testing supplies are as follows: For insulin dependent, max testing is how many times a day?
Medicare standard utilization guidelines for diabetic testing supplies are as follows: For insulin dependent, max testing is how many times a day?
When is insulin covered by Medicare Part B?
When is insulin covered by Medicare Part B?
Medicare Part D and Medicare Part B may be billed for the same item.
Medicare Part D and Medicare Part B may be billed for the same item.
Which date does Medicare consider the date of service that drives refill too soon rejections?
Which date does Medicare consider the date of service that drives refill too soon rejections?
If a beneficiary is concerned that the amount due at POS is too high, what should be advised?
If a beneficiary is concerned that the amount due at POS is too high, what should be advised?
Flashcards
Medicare Part B billing for CVS
Medicare Part B billing for CVS
CVS does not bill for certain items. A and B.
Medicare Part B claim adjudication
Medicare Part B claim adjudication
Claims are processed not in real-time.
Beneficiary prescription cost share
Beneficiary prescription cost share
After meeting the annual deductible, beneficiaries pay 20% of prescription costs.
Supplier standards form timing
Supplier standards form timing
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AOB form frequency
AOB form frequency
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Insulin dependence reporting
Insulin dependence reporting
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TPPC 22345 group ID
TPPC 22345 group ID
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Beneficiary owned equipment information
Beneficiary owned equipment information
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Assignment of Benefits form purpose
Assignment of Benefits form purpose
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Maximum daily diabetic testing
Maximum daily diabetic testing
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Insulin Part B coverage
Insulin Part B coverage
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Medicare Part B/D billing
Medicare Part B/D billing
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Date of service for refills
Date of service for refills
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High POS amount advice
High POS amount advice
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Study Notes
Medicare Part B Billing Overview
- CVS does not bill Medicare Part B for continuous glucose monitors and nebulizers.
- Medicare Part B claims are processed in a non-real time manner.
Beneficiary Cost Responsibilities
- After meeting the yearly deductible, beneficiaries are liable for 20% of prescription costs.
Supplier Standards and Forms
- A supplier standards form is required when requested by the beneficiary or their authorized representative and upon the first fill (fill 00).
- Assignment of Benefits (AOB) forms do not need to be collected with every Medicare Part B prescription fill at CVS locations.
Compliance and Reporting
- Correct reporting of insulin dependence and procedure modifier codes is crucial to avoid being categorized as waste under Medicare’s fraud regulations.
- Beneficiary-owned equipment information must be documented for durable medical equipment and respiratory products to comply with Medicare Part B billing guidelines.
Medicare Part B Guidelines for Diabetic Supplies
- The guidelines specify a maximum of three testing supplies per day for insulin-dependent individuals and one per day for non-insulin-dependent individuals.
- Insulin is covered by Medicare Part B only when administered via a pump.
- Items cannot be billed to both Medicare Part B and Part D simultaneously.
Claim Processing and Patient Interaction
- The date of service recognized by Medicare for processing claims and managing refill-to-soon denials is the point of sale (POS) sold date.
- If a beneficiary expresses concern about high POS costs for a Medicare Part B covered item, advise that deductibles and coinsurances must be collected per medical guidelines.
- Call omniSYS for deductible overrides if the patient has an active Medigap/Supplemental plan covering the deductible.
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Description
Test your knowledge of CVS Medicare Part B with these flashcards. Covering key concepts such as billing practices, claims adjudication, and beneficiary responsibilities, this quiz will enhance your understanding of Medicare Part B policies. Perfect for students or professionals in the healthcare field.
