Question about Medicare billing

[ldiot]

So it's been awhile since I've worked regularly and I've just started a new job, and I realized that I have forgotten a lot; specifically in terms of insurance.

So... Medicare part D is Rx insurance. Patients enrolled in Medicare are NOT automatically enrolled in part D, they have to specifically enroll in part D. So it is NOT true to say that anyone on Medicare has Rx coverage. Is this correct?

A patient with Medicare part D will ALWAYS have a separate Rx insurance card that is to be used; not the red white and blue card. Is this correct?

Some things have to be billed to Medicare part B; such as supplies.

Medicare part B includes what exactly in term of pharmacy? Here's my best guess, feel free to add remove items
Here my list:
-Nebulizer vials
-Test strips
-Lancets
-Glucose meter?
-BP monitor?
-Alcohol pads??? (strange that I've never actually dispensed this for a diabetic on insulin?)

When billing part B, what card is used? Do you have to use the red white and blue card for this? Even if they don't have the red white and blue card on them their ID is their SS# so you don't really need the physical card anyways right?

Are vaccines billed to part B or part D???

Thanks a lot, I really appreciate any help/response.

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[Dennis Byron]

1. You are correct. Not everyone on Medicare has drug insurance. However many people on Medicare (but a decreasing percentage) have private drug insurance not related to Part D. And many other people get a Part D like coverage through Part C
2. It is correct that the approximately 33% of people on Medicare who have pure Part D will have a Part D card (but doesn't mean much usually; almost all pharmacies have the information online)
3. There are many Part B drugs not listed on your list
4. Many Medicare patients' Medicare number is their SS followed by various letters (but few of us know what letter is used for us specifically without looking at the card). However many Medicare patients' Medicare ID is not close to their SS number, particularly spouses whose Medicare coverage comes because of their partner. And over time, all Medicare numbers will be different for privacy reasons
5. Some vaccines are B and some are D

I am a Medicare recipient. Good to see a provider who is looking at it from the patient's point of view

 

[trailerpark]

Flu and pneumonia are part B, rest part D.


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[ldiot]

Flu and pneumonia are part B, rest part D.


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If you need to bill part B you use the red white and blue card?

 

[trailerpark]

If you need to bill part B you use the red white and blue card?

Yes



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[notwesteast]

Good info.

 

[zelman]

Overlapping Coverage Determinations

Unfortunately, what may appear to be a clear distinction of Part B and Part D coverage is not. Some categories of drugs covered under Part D continue, in some circumstances, to be covered under Part B in a variety of settings, under a variety of payment methodologies and in varying clinical situations. Many of these drugs may be covered under either Part B or Part D. Drug classes where uncertainty as to which Medicare program provides coverage include, but are not limited to:

•  Drugs requiring the use of durable medical equipment (DME)
  
  
•  Drugs furnished “incident to” a physician service
  
  
•  Immunosuppressant drugs
  
  
•  Oral anti-cancer drugs
  
  
•  Oral anti-emetic drugs
  
  
•  Erythropoietin (EPO)
  
  
•  Prophylactic vaccines
  
  
•  Parenteral nutrition
  

 

[waiter]

Very annoying when ondansetron rejects on Part D for a "B vs. D" determination. Some plans will let you tell them it's not for cancer, but other plans require the doctor to submit a PA.