Question

1. What four circumstances will prompt Medicare to award conditional primary payer status to an assigned claim?

2. List the services that physician or other health care practitioner cannot bill for any services or supplies for at least two years.

Answer 1

1)The 4 circumstances will prompt medicare to award conditional primary payer stsatus to an assigned claim: the conditional primary payer status : it is the medicare will award an assigned claim and process the claim under certain circumstances, medicare is to be reimbursed immediately if payement is recieved from the primary payer at a later date, circumstances: 1) when there is no response from a liability payer within 120 days of filing the claims, 2) the COBRA( Consolidated omnibus budget reconciliation act of 1985) it allows an employee or an empolyees dependent to maintain group health insurance coverage through an employers health inmsurance plan at the indiviudals exoense for upto 18 months in certain circumstances and it may be extended beyond 18 months in certain sircumstances 3) if the employee losses coveraage through loss of employment or due to reduction in work hours then the COBRA rules apply 4) COBRA benefits are extended to spouses or dependents in case of divorce or the deeath of the employee , 5) children who are born to, adopted , or placed for adoption with the covered employee while he or she is on COBRA coverage are entitled to coverage. 2)List the services that physician or other health care practitioner cannot bill for any servies or supplies for at least 2 years: a) the physician may not bill an initial or subsequent observation care code for services on the data that he or she admits the patient to inpatient status,b no billing for other physician for second visit, c) initial hospital care from emergency room:it physicain see a patient in the emergencyroom and decides to admit the person to the hospitalthen they do not pay for both emergency / medical services and also they do not pay for an emergency department visit by the same physician on the same date of services . etc