On October 1, 2001 the Department of Defense implemented TRICARE for Life (TFL). TRICARE for Life provides expanded medical coverage for: Medicare-eligible uniformed services retirees, including retired National Guard members and reservists; Medicare-eligible family members and widows/widowers; and certain former spouses if they were eligible for TRICARE before age 65. To be eligible for TFL you must be over 65 and have Medicare Part A and B to your coverage.
You get all Medicare-covered benefits as well as TFL-covered benefits as you would under the Original Medicare Plan if you are eligible. When you are using a provider that is Medicare based then Medicare will pay first and TFL second. All co-payments and deductibles required by Medicare will be paid by TFL as well as the costs of certain care that Medicare does not offer.
Note:
If Medicare is the only one to offer a service like chiropractic care you will be responsible for anything not paid to the provider by Medicare.
The same goes for a service provided only by TRICARE, such as certain prescription drugs, you would be responsible for anything not paid by TRICARE. Using a Medicare provider will be a big part of the amounts that TRICARE or Medicare will pay for a service.
Thursday, August 5, 2010
Wednesday, August 4, 2010
Medicare's 72 Hours rule
Medicare's 72 Hours rule:
The 72-hour rule treats outpatient services the same as inpatient services.
The rule states that all services provided for Medicare patients within 72 hours of the hospital admission are considered to be part of the inpatient services and are to be billed on one claim.
The 72-hour rule is part of Medicare's Prospective Payment System (PPS).
Under the PPS, Medicare pays hospitals a pre-determined rate for each hospital admission.
Clinical information is used to classify each patient into a Diagnosis Related Group (DRG). Such information includes the principal diagnosis, complications and co-morbidities, surgical procedures, age, gender, and discharge disposition of the patient. It is very important for hospital personnel to properly code the diagnoses and procedures, since that information is what determines what DRG Medicare assigns to the patient. Incorrectly coded diagnoses and dramatically effect reimbursement, as rates are determined by the DRG.
Acute care hospitals require the 72-hour rule. Other facilities require the 24-hour rule, such as long-term care hospitals, rehab hospitals, and psychiatric hospitals. Critical access hospitals are excluded from the 72-hour/24-hour provision. Improper coding and billing can cause unnecessary hassles.
The 72-hour rule treats outpatient services the same as inpatient services.
The rule states that all services provided for Medicare patients within 72 hours of the hospital admission are considered to be part of the inpatient services and are to be billed on one claim.
The 72-hour rule is part of Medicare's Prospective Payment System (PPS).
Under the PPS, Medicare pays hospitals a pre-determined rate for each hospital admission.
Clinical information is used to classify each patient into a Diagnosis Related Group (DRG). Such information includes the principal diagnosis, complications and co-morbidities, surgical procedures, age, gender, and discharge disposition of the patient. It is very important for hospital personnel to properly code the diagnoses and procedures, since that information is what determines what DRG Medicare assigns to the patient. Incorrectly coded diagnoses and dramatically effect reimbursement, as rates are determined by the DRG.
Acute care hospitals require the 72-hour rule. Other facilities require the 24-hour rule, such as long-term care hospitals, rehab hospitals, and psychiatric hospitals. Critical access hospitals are excluded from the 72-hour/24-hour provision. Improper coding and billing can cause unnecessary hassles.
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