2 min read

[BLOG] Know Your ABD's: The Medicare Open Enrollment Period Has Begun!

By Prime Care Tech Marketing on Mon, Oct 23, 2023 @ 07:20 AM

If you’re 65 years old, about to be 65 years old, or if you know somebody who is, here’s a message for you: Don’t wait to sign up for, or change, Medicare insurance plans - poor planning, procrastination and missed deadlines expedite the aging process!

The Medicare Open Enrollment Period is October 15th through December 7th, and it’s time to make decisions about your future now - changes made during this period will take effect January 1st of next year.

Here’s a brief overview of some upcoming deadlines:

  • Part A, B, D – Enrollment begins 3 months before and up to three months after you turn 65.
  • Medicare Supplement Insurance (Medigap) – Medigap open enrollment lasts 6 months and begins when 1) You are 65 or older 2) Have enrolled in Medicare.
  • Working past age 65 – You must enroll within 8 months of being unemployed or dropping your health plan.

What each part means:

Part AHospital insurance: Covers inpatient care, hospice, home health and skilled nursing care.

Part BMedical insurance: Covers outpatient care, preventative services and medical equipment such as wheelchairs and walkers.

Part DPrescription drug coverage

Medicare Supplement Insurance (Medigap)Covers some of Medicare’s cost-sharing requirements and services not covered by Medicare.


Why you should take advantage of this enrollment period:

  • Possibility of upgrading or downgrading plans (Medicare Advantage versus Original)
  • Opportunity to reevaluate or change Part D
  • Peace of mind knowing that you do not have to rely on COBRA or job security in order to be covered by insurance.

Good to know:

  • The general enrollment period for Medicare is between January 1st and March 31st
  • During the general enrollment period, coverage kicks in one month post-enrollment.
  • You can apply for Medicare even if you are already covered elsewhere.

Topics: Medicare Part A Medicare Eligibility Prime Care Technologies medicare advantage #solutions
3 min read

Taking the Headaches Out of Secondary Claims

By Prime Care Tech Marketing on Mon, Nov 09, 2015 @ 06:55 PM

Secondary ClaimsFor CFOs, the bottom line matters, whether it’s the P&L or identifying what’s in the bank. Occasionally, though, it does help to know within the context of “what’s in the bank,” how the money gets there. Since Medicare Part A is a significant revenue source, being aware that just submitting a claim for Part A-covered days-of-service may not be enough can be helpful to supporting the organization’s efforts to create an impediment-free flow of cash to the bank.

Let’s take a closer look at the obvious. Assuming the resident meets all the Part A eligibility requirements and that he or she receives Medicare-coverable services, the Medicare MAC will pay the entire amount of the RUG-determined per diem for the first 20 days of the spell of illness. The “rub” is who pays for the coinsurance for the remaining days of qualified services from the 21st day onward? This is where the secondary payer comes in and, potentially, the headaches.


Secondary claims, if not properly handled (and I mean filed electronically, not manually – more about that in a moment) can slow up cash flow. “A claim is a claim, isn’t it?” Nope. "Well, I’ve got the staff and I am certainly paying enough for them to process the claims. They know what they’re doing.” Yes, but because of the intricacies of submitting the secondary claim after receiving payment from the primary payer, providers can and often do see a delay in payment or no payment at all. “But why?” you may ask.

A little background

Once Medicare pays the claim, the MAC may through a coordination of benefits agreement automatically forward the secondary claim to the secondary payer. But not in all cases. Only if the secondary payer pays a fee for such services. The secondary payer can be a commercial insurance (Medi-Gap) or Medicaid. In some states, Medicaid secondary payer claims will cross over automatically. However, even if the state automatically processes the secondary claim, some states do not pay the entire coinsurance amount.

In those cases where the secondary payer does not pay the fee for Medicare to automatically forward the secondary claim, the provider’s Central Billing Office or AR staff or Billers will have to identify, process, submit, monitor, and intervene as needed to collect the secondary payer payment. They can do this manually (Really?) or electronically (Get with the program, folks.).

Manual or electronic processing – showing our bias

Let’s look at the two alternatives.

Paper-based secondary claims – This process is as old as dirt. Because there are many nuances to the process and opportunities for omissions, errors, and procrastination, it creates delays. The billing department receives notices of payment from the primary payer. Then billers have to print the UB04, attach the claim level, related remittance advice, and mail or fax these papers to the secondary payer. The manual method usually requires a tickler file, likely an accordion file with 30 slots in which to place copies of the submitted documents for follow-up. On the follow-up day, the biller places a call to the payer. Unfortunately, it’s not unusual for the payer to not have a record of the submission. So the biller will have to resubmit the claim again and move the claim documentation further back in the accordion file.

Oh, and here is another possible “...grant me the serenity to accept the things I cannot change…” moment. Some secondary payers require a 15-30-day waiting period before a provider can resubmit the claim. How’s that for taking the starch out of your shirt?

Because preparing, filing, and following up on secondary payer claims can engender procrastination, it's easy to lose track of the secondary payer claims. This can result in further payment delays or no payment at all, if the submission takes place outside the allowable filing window (sometimes 90 days to a year).

Electronic claims – the aspirin of secondary claims processing

Processing secondary payer claims electronically through a clearinghouse is as fast and easy to follow as this paragraph. Because the process of claims preparation to submission to follow-up to payments is automated, it gets the job done faster. It also helps to reduce the staff hours consumed when processing claims manually. Word to the wise, “Use the technology at hand.” 

What can a CFO do?

The bottom line looks much healthier, because the provider electronically processes not only primary payer claims, but secondary claims as well. It’s certainly one less headache.

And that makes cents.


Claims Process

Topics: Medicare Part A clearinghouse Medicare Secondary Payer MAC UB04 Medi-Gap
2 min read

Getting Paid for Part A Therapy Services

By Prime Care Tech Marketing on Tue, Nov 15, 2011 @ 06:19 PM

Billing Medicare Part A for Ancillary Therapy Services - a change in what units represent

Focusing on Medicare’s coverage and payment for ancillary therapy services,Proper Therapy Unit Codes Transmittal 2239 (CMS Manual, Pub 100-04 Medicare Claims Processing, issued June 14, 2011, Billing SNF PPS Services, 30.4 - Coding PPS Bills for Ancillary Services) states, effective August 1, 2011, “For therapy services, that is revenue codes 042x, 043x, and 044x, units represent the number of calendar days of therapy provided.  For example, if the beneficiary received physical therapy, occupational therapy and speech-language pathology on May 1, that would be considered one calendar day and would be billed as one unit.” (Italics added.)

In other words, for each day a Medicare patient receives a therapy service, providers must record that as one unit. In the past, the number of units reported on a claim reflected the number of treatments provided. That is no longer the case. The new policy stipulates that units of therapy should tie to the number of days the patient received therapy services, NOT the number of treatments. For codes 042x, 043x, and 044x, providers are to record the total number of days a resident received therapy treatments as one unit for each day. Providers can look at this as an “on/off switch,” “yes or no” answer. Did the resident receive PT today? If, “yes,” then record 1 unit. If a resident had 16 days of physical therapy treatments, for example, the 042x revenue code should indicate 16 units. The aggregate of the total units/days of therapy services received would be recorded on the claim. 

The transmittal further stipulates that “SNFs are required to report the actual charge for each line item, in Total Charges.” The total should reflect the charges for actual treatments received as determined by your facility’s/company’s charge master and recorded in the Total Charges field.


If you are using a clinical software application for documenting therapy services, does it automatically convert days of service to units to be recorded in aggregate on the claim while recording the charges based on the quantity of treatments?

What changes were necessary for you to comply with this regulatory change?

With the hiring of Ms. Becky Bos and Ms. Kimberly Kelly, PCT offers enhanced Revenue Management Consulting Services to long term care providers. Cuts in Medicare and Medicaid services have forced providers to effectively maximize and capture the revenue they are able generate. Becky and Kimberly have extensive experience and expertise in working with large multi-facility corporations and small regional providers to identify and collect the cash owed. This is the first in a series of articles in which Becky and Kimberly share their collective wisdom regarding sound billing and collection practices providers can employ.

Topics: Part A Therapy Services therapy units transmittal 2239 042x 043x 044x therapy codes Medicare Part A revenue cycle management


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