What is Part C reporting?
This section contains information related to CMS' Medicare Advantage (Part C) reporting requirements. Each Medicare Advantage organization must have an effective procedure to develop, compile, evaluate, and report information to CMS in the time and manner that CMS requires.
What is Medicare Part C EOB?
The EOB provides monthly and year-to-date summaries of an enrollee's drug plan costs. These summaries include a breakdown of the drug plan costs paid during each drug payment stage.
Is Medicare Part C required?
You don't need to buy a Medicare Part C plan. It's an alternative to original Medicare that offers additional items and services. Some of these include prescription drugs, dental, vision, and many others.
How is Medicare C provided?
Medicare Part C plans are insurance plans offered by private insurance companies. These plans, otherwise known as Medicare Advantage plans provide the same coverage as original Medicare with the benefit of supplemental coverage. If you already receive Medicare Part A and Part B, you're eligible for Medicare Part C.
Is Kaiser Senior Advantage the same as Medicare Part C?
Medicare Part C, or Medicare Advantage, is offered by private health care providers. Medicare Advantage is an all-in-one plan that bundles Original Medicare (Part A and Part B) with additional benefits. Kaiser Permanente Medicare health plans are examples of Medicare Advantage plans.
What is required on an EOB?
An explanation of benefits (EOB) may include, among other things, information about: The type of service provided and the date of service. The amount a plan provider billed for the service. Any discount the participant or beneficiary received for using an in-network provider.
Does Medicare Part C include A and B?
Medicare Part C plans cover Part A and Part B, and many also include prescription drug coverage (Part D) and other benefits not available with Original Medicare.
Does Medicare Part C replace A and B?
Part C (Medicare Advantage) Under Medicare Part C, you are covered for all Medicare parts A and B services. Most Medicare Advantage plans also cover you for prescription drugs, dental, vision, hearing services, and more.
Can you add Part C to Medicare?
During certain times each year (yearly enrollment periods for Part C & Part D) Each year, you can make changes to your Medicare Advantage or Medicare drug coverage for the following year. There are 2 separate enrollment periods each year: Open Enrollment Period for Medicare Advantage and Medicare drug coverage.
What type of insurance is Medicare Part C?
Medicare Part C is a type of insurance option that offers traditional Medicare coverage plus more. It's also known as Medicare Advantage. Some Medicare Part C plans offer health coverage benefits such as gym memberships and transportation services.
Is Medicare Part C the same as supplemental insurance?
These are also called Part C plans. Medicare Supplement insurance policies, also called Medigap, help pay the out-of-pocket expenses not covered by Original Medicare (Part A and B). It is not part of the government's Medicare program, but provides coverage in addition to it.
What does Ma bill option code C mean?
Restricted plans (Option code C) All claims must be submitted to the MA plan for processing with a few exceptions.
How to contact HPMS for DIR?
For technical assistance and questions regarding the download or upload of the DIR Reports, please contact the HPMS Help Desk at 1-800-220-2028 or [email protected] any other questions regarding this guidance, please contact: [email protected].
When to resubmit DIR report HP?
To report a known change or error in the DIR amounts reported for contract year 2014, Part D sponsors must submit an updated Summary DIR Report in HP MS using the 2014 Report template during the DIR resubmission period from July 1, 2019 through 11:59 PM PT on July 31, 2019. The resubmission window will open for all Part D sponsors to resubmit the Summary DIR Report for contract year 2014. If a sponsor does not need to resubmit a report, please disregard any email notifications sent out regarding the resubmission window.
What is a DIR report?
In the Summary DIR Report, Part D sponsors will be responsible for reporting multiple data elements related to DIR at the plan benefit package (PBP) level. DIR data must be summarized for each PBP and reported in aggregate to include multiple drugs and price concessions.
What is Medicare Part D?
In December 2003, Congress passed the Medicare Prescription Drug Benefit, Improvement and Modernization Act (MMA) (P.L. 108-173), allowing coverage of certain outpatient prescription drugs under the new Medicare Part D benefit. Reinsurance and risk-sharing are two of the payment mechanisms by which the Medicare Program reimburses Part D sponsors for providing prescription drug coverage. CMS is required by statute to base these payments on a Part D sponsor’s “allowable reinsurance costs” and “allowable risk corridor costs,” which must be “actually paid.” As defined at 42 CFR 423.308, “actually paid” costs must be actually incurred by the Part D sponsor and net of any applicable direct or indirect remuneration (DIR).
When is the DIR resubmission period for HP?
To report a known change or error in the DIR amounts reported for contract years 2015, 2016, and 2017, Part D sponsors must submit an updated Summary DIR Report in HP MS using the 2015, 2016, and 2017 Report template, as appropriate, during the DIR resubmission period from July 1, 2019 through 11:59 PM PT on July 31, 2019. Part D sponsors also have the option to request that CMS, at its discretion, reopen and revise the sponsor’s final Part D payment determinations to reflect its reported changes in DIR.
When resubmitting the Summary or Detailed DIR Report for 2018 due to a plan or CMS discovered data error
When resubmitting the Summary or Detailed DIR Report for 2018 due to a plan or CMS discovered data error, Part D sponsors are required to provide an explanation for the resubmiss ion of their DIR data.
Can I update my DIR report for 2013?
To report a change or error in the DIR amounts reported for contract year 2013, sponsors may not simply upload updated Summary DIR Reports. Instead, they must submit a reopening request, as described in the June 1, 2017 HPMS memorandum title d “Updates to the Reopening Request Spreadsheet.” If a reopening request is granted, the sponsor will be notified to resubmit an updated Summary DIR Report (using the applicable template for the applicable contract year).
