Medicare Archives

Medicare Secondary Payment/Group Health Plan Worksheet

Utilizing Medicare Payment Tools This form is one of the most helpful tools in the KMC University Library. When Medicare is a secondary payer, it can be confusing to know what fee schedule to use, how much coinsurance to charge, or whether other insurance may pay for items excluded by Medicare. As you’ll see in…

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When Medicare is the Secondary Payer

Although Medicare is usually the primary payer for most beneficiaries, there are times when Medicare takes the second position. Because the federal funds used to pay Medicare claims are so closely monitored, the Coordination of Benefits (COB) department of a Medicare Administrative Contractor (MAC) carefully screens claims to be sure Medicare is paying as they…

FDR Guidance

First Tier, Downstream and Related Entities (FDR) Guide Aetna’s in-depth guide to the FDR Medicare Compliance Program is an excellent resource for new employees and for seasoned employees who must deal with an unusual or new situation with one of your Medicare patients. It addresses the attestation requirements for the program in detail and explains…

Medicare Advantage & FDR

First Tier, Downstream, or Related Entity FDR is a Centers for Medicare and Medicaid Services (CMS) acronym for First tier, Downstream, or Related entity. A First Tier Entity is any party that enters into a written arrangement (acceptable to CMS) with a Medicare Advantage (MA) organization to provide administrative or health care services to a…

FAQs-Medicare Advantage Plans

Medicare Advantage Plans FAQs Q: What is a Medicare Advantage Plan? A: According to www.Medicare.gov, a Medicare Advantage Plan (like an HMO or PPO) is a Medicare health plan that qualified beneficiaries may choose as part of their Medicare packages. These plans are very similar to traditional Health Management Organizations (HMOs), Preferred Provider Organizations (PPOs)…

Billing Medicare Advantage

Important Facts about MA Plans Although a Medicare Advantage (MA) plan is technically a form of Medicare coverage, it is best to view these plans similarly to your contracted commercial payers. Advantage Plans often follow the same billing rules as regular commercial carriers. If you are a contracted provider for the plan the patient belongs…