Before we get into specifics with Medicare, here’s a quick note on the administrative process involved. When a claim is sent to Medicare, it’s processed by a Medicare Administrative Contractor (MAC). The MAC evaluates each claim sent to Medicare and processes the claim. This process usually takes around 30 days.
When billing for traditional Medicare billers will follow the same protocol as for private, third-party payers, and input patient information, NPI numbers, procedure codes, diagnosis codes, price, and Place of Service codes. You can also get choose SNF Billing to get Skilled Nursing Facility Solutions & Nursing Home A/R Billing online.
Image Source: Google
Like billing to a private third-party payer, billers must send claims to Medicare and Medicaid. These claims are very similar to the claims you’d send to a private third-party payer, with a few notable exceptions.
Since these two government programs are high-volume payers, billers send claims directly to Medicare and Medicaid. That means billers do not need to go through a clearinghouse for these claims, and it also means that the onus for “clean” claims is on the biller. If a biller has to use manual forms to bill Medicare, a few complications can arise.
For the most part, however, billers will enter the proper information into a software program and then use that program to transfer the claim to Medicare directly.