Riverbend

MedAdvantage

Medicare Cost Reporting

• Claims: Medicare Advantage claims should NOT be submitted for processing through Riverbend
• Visits: Medicare Advantage visits should NOT be included as a Medicare visit, but SHOULD be included in total visits
• Rate Negotiation:
  • Pneumo and flu injections are reimbursed separately from the visit rate, as well as, bad debt expense. These costs should be considered when negotiating Part D rates.
• If a rural health provider prefers to treat Medicare Advantage enrollees on a non-contract basis, Federal law requires that ALL Medicare Advantage Plans should pay not less than what would have been received for the same service under original Medicare payment rules (or cost-based rates).
• Medicare Advantage Certification Form
• RHC Courier Volume 12, Issue 3
• Update: MLN Matters Number 0727 addresses coverage of vaccines under the Part D Program. 
  • Effective 1/1/08 Part D program will cover vaccine administration costs associated with Part D vaccine.
  • http://www.cms.hhs.gov/MLNMattersArticles/