Policy Examples

  • The contract between CMS and Medicare Advantage(MA) organization must provider that the MA organization will pay 95 percent of the “clean claims” (a claim without defect, impropriety, lacks documentation, or has a special circumstance) within 30 days of receipt if they are submitted by, or on behalf of, an enrollee of an MA private fee-for-service plan or are claims for services that are not furnished under a written agreement between the organization and the provider. source & source

Outcome Evidence

  • Many hospitals struggle to optimize Medicare Bad Debt (MBD) reimbursements because of the differences in billing processes across the three types of MBD: crossovers, which pertain to dual-eligible patients, traditional bad debt, which refers to patients with Medicare as their primary insurer, and indigent bad debt, for those who simply cannot pay medical bills. source

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