Questions and Answers
CVS does not currently bill Medicare Part B for which of the following?
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?
20%
When is a supplier standards form required to be provided to the beneficiary?
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AOB forms must be collected every time a beneficiary fills a Medicare Part B prescription at any CVS location.
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Failure to report the correct insulin dependence indication may be considered waste under Medicare's fraud regulations.
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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.
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Beneficiary owned equipment information prompts must be completed to remain compliant with Medicare Part B billing guidelines.
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What is the purpose of the assignment of benefits form?
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Medicare standard utilization guidelines for diabetic testing supplies are as follows: For insulin dependent, max testing is how many times a day?
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When is insulin covered by Medicare Part B?
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Medicare Part D and Medicare Part B may be billed for the same item.
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Which date does Medicare consider the date of service that drives refill too soon rejections?
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If a beneficiary is concerned that the amount due at POS is too high, what should be advised?
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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.
