CVS Pharmacy

-Continuous glucose monitors -nebulizers
Explanation: CVS does not currently bill Medicare Part B for a number of reasons. First, CVS is not a participating provider in the Medicare program. Second, CVS does not have a contract with Medicare to provide services to Medicare beneficiaries. Finally, CVS does not have the necessary billing and coding infrastructure in place to bill Medicare Part B for services rendered.

Non-real time
Explanation: There are a few different ways that Medicare Part B claims can be adjudicated, or processed. One way is through a Medicare Advantage Plan, which is a type of health insurance plan that is offered by a private company and approved by Medicare. These plans usually have their own network of doctors and hospitals that you can use, and they will process your claims for you. Another way to have your Medicare Part B claims adjudicated is through a Medicare Supplement Insurance Plan, which is a type of insurance that helps cover some of the costs that Medicare doesn't cover. These plans are also offered by private companies, but they don't have their own network of providers. Instead, they will reimburse you for the care that you receive from any Medicare-approved provider.

0,2
Explanation: Beneficiaries are responsible for a copayment or coinsurance of prescription costs after their yearly deductible has been met.

-When requested by the beneficiary on their authorized representative -upon the fist fill (i.e, fill 00)
Explanation: There is no definitive answer to this question as it will depend on the specific contract between the supplier and the beneficiary. However, in general, a supplier standards form may be required to be provided to the beneficiary in cases where the beneficiary has specific requirements or standards that the supplier must meet in order to be considered eligible for payment. For example, if the beneficiary has a policy of only paying suppliers who are certified by a certain organization, the supplier standards form would need to include documentation of this certification.

FALSE
Explanation: AOB forms are required in order to process Medicare Part B prescriptions at CVS locations. The AOB form must be completed and signed by the beneficiary in order to receive reimbursement for the cost of the prescription.

TRUE
Explanation: If a provider bills for insulin but does not report the correct procedure modifier code to indicate that the patient is insulin dependent, Medicare may consider this to be waste under its fraud, waste and abuse regulations. This is because the provider is not accurately reporting the services that were provided, and Medicare may not reimburse for the services if they are not properly coded.

TRUE
Explanation: to the state with the corresponding IDIf the group ID of TPPC 22345 is populated with a state abbreviation and medicaid ID or a COBA ID, this will result in a claim being auto-crossed to the state with the corresponding ID. This is because TPPC 22345 is a federally-designated provider type and state medicaid ID or COBA ID is required for auto-crossing.

TRUE
Explanation: The beneficiary owned equipment information prompt must be completed on DTS and respiratory products to remain compliant with Medicare Part B billing guidelines and to avoid denials. This is because Medicare Part B requires that all medical equipment be properly documented in order to be eligible for reimbursement, and the DTS system is the best way to ensure that this documentation is completed accurately and in a timely manner.

authorize CVS pharmacy to b ill medicare for payment and serves as a medical release authorization
Explanation: ?The assignment of benefits form is a legal document that outlines the agreement between a service provider and a customer. The form details the customer's responsibility to pay for services received, as well as the service provider's responsibility to provide the services. The form also includes information on how the customer can cancel the agreement, and what happens if the service provider is unable to provide the services.

-for insulin dependent, max testing 3x a day -for non-insulin dependent, max 1x a day
Explanation: 1. Medicare will cover up to 100 strips per month for beneficiaries with Type 1 or Type 2 diabetes.2. Medicare will cover up to 300 strips per month for beneficiaries with Type 2 diabetes who use an insulin pump.3. Medicare will cover up to 200 strips per month for beneficiaries with gestational diabetes.4. For all other beneficiaries with diabetes, Medicare will cover up to four strips per day.

when administered via a pump
Explanation:1. Medicare will cover up to 100 strips per month for beneficiaries with Type 1 or Type 2 diabetes.2. Medicare will cover up to 300 strips per month for beneficiaries with Type 2 diabetes who use an insulin pump.3. Medicare will cover up to 200 strips per month for beneficiaries with gestational diabetes.4. For all other beneficiaries with diabetes, Medicare will cover up to four strips per day.

FALSE
Explanation: .There are two possible explanations for this:1) The item may be covered by both Medicare Part D and Part B. In this case, the patient would be responsible for paying the deductible and coinsurance for both programs.2) The item may be covered by Medicare Part D, but not Part B. In this case, the patient would be responsible for paying the deductible and coinsurance for Part D, but would not be able to bill Medicare for the item.

POS sold date
Explanation: There are a few different things that can drive a refill too soon" rejection from Medicare. One is if the patient has not yet met their deductible for the year. Another is if the Part D plan has a "coverage gap" or "donut hole" - this is a period of time during the year when the patient is responsible for a larger portion of their prescription drug costs. Finally, if the patient has reached the maximum number of days supply for their prescription, they will need to get a new prescription from their doctor before their Part D plan will cover it."

all 3 -advise the patient their deductible and coinsurances must b collected at POS per medical guidelines. -only sequence valid plan on the medicare part B clam according to coordination of benefit guidelines -if the patient has an active medigap/supplemental c,g, or J plan that covers their deductible, call omniSYS for a deductible override.
Explanation: There are a few potential reasons for this. One possibility is that the beneficiary has reached their Part B deductible for the year. Once the deductible is met, Medicare Part B covers 80% of the approved amount for covered services. The remaining 20% is the responsibility of the beneficiary.It's also possible that the beneficiary has elected to receive Part B coverage through a private insurance company, rather than through Medicare itself. In this case, the private insurer may have a different coverage amount than Medicare, resulting in a higher balance due at the point of service.Finally, it's possible that the service being billed is not covered by Medicare Part B. In this case, the beneficiary would be responsible for the full amount of the bill.