Saturday, April 9, 2011

checking eligibility through Medicare IVR

DME MAC A IVR User Guide - Eligibility Options

Eligibility - Option 2

When the eligibility option is selected, the IVR will request the following elements:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• Beneficiary Medicare number
• Beneficiary first and last name (last name and first initial if using touch-tone)
• Beneficiary date of birth
• Date of service

Once the authentication elements have been verified, the IVR will supply the following, if applicable:

• Part A and Part B effective/termination dates
• Current/prior year Part B deductible amounts
• Medicare Secondary Payer (MSP) type, insurer name, and effective/termination dates
• Medicare Advantage Plan number, name, address, telephone number and effective/termination dates
• Home health name, address, and effective/termination dates
• Hospice name, address, and effective/termination dates
• Date of death
• Corrected Medicare number

At any time during eligibility playback the caller can give the next Medicare number if multiple eligibility
requests are needed.
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download