Or. Admin. R. 410-148-0160 - Billing for Clients Who Have Both Medicare and Basic Health Care Coverage

(1) The Divisin of Medical Assistance Programs (Division) may be billed directly for services provided to a client when the provider has established and clearly documented in the client's record that the service provided does not qualify for Medicare reimbursement.

(2) When the service qualifies for Medicare reimbursement, bill as follows:

(a) When billing for home enteral/parenteral nutrition services:

(A) Bill in the usual manner to the local or designated Medicare Intermediary;

(B) After Medicare makes a payment determination, bill the Division on the DMAP 505 form following the billing instructions and using the procedure codes listed for the home enteral/parenteral nutrition and IV Services in the fee schedule and supplemental materials;

(b) When billing for Home IV services:

(A) Bill the local Medicare Intermediary in the usual manner;

(B) After Medicare makes payment determination, bill DMAP following the billing instructions and using the procedure codes listed for the Home Enteral/Parenteral Nutrition and IV Services fee schedule and supplemental materials.

Notes

Or. Admin. R. 410-148-0160

HR 9-1992, f. & cert. ef. 4-1-92; HR 26-1993, f. & cert. ef. 10-1-93; HR 3-1995, f. & cert. ef. 2-1-95; OMAP 7-1998, f. 2-27-98, cert. ef. 3-1-98; OMAP 46-2001, f. 9-24-01, cert. ef. 10-1-01, Renumbered from 410-121-0750; OMAP 63-2003, f. 9-5-03, cert. ef. 10-1-03

Publications: Publications referenced are available from the agency.

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 414.065