Medicare Eligibility (Part A)

NGSConnex allows providers to check eligibility prior to submitting a claim.

• True

• False

How would you check eligibility in NGSConnex?

• Initiate Eligibility

• My Claims

• Account Management

If The NGSConnex eligibility files show that a beneficiary has Medicare Advantage, where will you submit your Medicare claim(s)?

• Palmeto GBA

• Medicare Advantage Plan the beneficiary is enrolled in

• National Government Services

After checking the Medicare eligibility files, you find the beneficiary you are treating is in a hospice election plan of treatment, but you are not treating the beneficiary for the terminal illness, what modifier will you use when you submit your claim?

• GW appropriate when service not related to the hospice patient’s terminal condition.

• 24 appropriate for unrelated evaluation and management service by same physician during post-op period

• 50 to identify procedures done bilaterally

After checking the Medicare eligibility files, you find the beneficiary you are treating is in a hospice election plan of treatment, but your doctor is not employed or associated with hospice agency, what modifier do you use when submitting your claims?

• GV appropriate when a physician is providing a service that is related to the diagnosis, but the physician is not associated with the hospice and is providing services as the attending physician.

• 24 appropriate for unrelated evaluation and management service by same physician during post-op period

• 50 to identify procedures done bilaterally

When a beneficiary is in a skilled nursing facility (SNF), the SNF is ultimately responsible for all the patient care at SNF.

• True

• False

In NGSConnex, to initiate an eligibility information search for a different Medicare beneficiaries, click the Search button in the Beneficiary Eligibility Information panel.

• True

• False

Medicare is always the primary payer.

• True

• False

If a beneficiary is in a home health plan of care, Medicare Part B will also pay for therapy services outside the home health benefits

• True

• False

A beneficiary that has Medicare Advantage could also have traditional Medicare the same time.

• True

• False