CVS Medicare Part B Flashcards and Quiz

CVS does not currently bill Medicare Part B for which of the following?

Medicare Part B claims are adjudicated in a/an _____ manner.

Beneficiaries are responsible for what percentage of prescription costs after their yearly deductible has been met?

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.

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.

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?

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?

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?

If a beneficiary is concerned that the amount due at POS is too high, what should be advised?

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.

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.