Another important benefit of the QMB program is that Medicare providers won’t be allowed to bill you for any Medicare-approved services or items. However, if you also receive Medicaid, you may be billed for a small Medicaid copay. To qualify for QMB, you have to meet income and resource...
What is Medically Necessary Under a Medicare Advantage Plan? If you are enrolled in a Medicare Advantage plan, your plan must go through the same process as Original Medicare to determine the necessity of the service you are receiving. As you know, Medicare Advantage plans must cover the same...
That means the physician must have seen the patient at some time to initiate the plan of care.” Is CPT code 98960 a payable code? If so, what is the appropriate modifier? That depends on the payer’s policy. Medicare, for example, bundles this code—as do many other payers. However,...