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Library: Policy

317:30-5-113. Medicare eligible individuals

Issued 10-03-05

     Payment is made to hospitals for services to Medicare eligible individuals as set forth in this section.

  • (1) Individuals eligible for Part A and Part B.
    • (A) Payment is made utilizing the Medicaid allowable for comparable Part B services.
    • (B) Payment is made for the coinsurance and/or deductible for Part A services for categorically needy individuals.
  • (2) Individuals who are not eligible for Part A services.
    • (A) The Part B services are to be filed with Medicare.  Any monies received from Medicare and any coinsurance and/or deductible monies received from OHCA must be shown as a third party resource on the appropriate claim form for inpatient per diem.  The inpatient per diem should be filed with the fiscal agent along with a copy of the Medicare Payment Report.
    • (B) For individuals who have exhausted Medicare Part A benefits, claims must be accompanied by a statement from the Medicare Part A intermediary showing the date benefits were exhausted.
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