OAR 410-148-0160: Billing for Clients Who Have Both Medicare and Basic Health Care Coverage

(1) The Division of Medical Assistance Programs (Division) may be billed directly for services provided to a client when the provider has established and clearly documented in the client's record that the service provided does not qualify for Medicare reimbursement. (2) When the service qualifies for Medicare reimbursement, bill as follows: (a) When billing for home enteral/parenteral nutrition services: (A) Bill in the usual manner to the local or designated Medicare Intermediary; (B) After Medicare makes a payment determination, bill the Division on the DMAP 505 form following the billing instructions and using the procedure codes listed for the Home Enteral/Parenteral Nutrition and IV Services in the fee schedule and supplemental materials; (b) When billing for Home EPIV services: (A) Bill the local Medicare Intermediary in the usual manner; (B) After Medicare makes payment determination, bill the Division following the billing instructions and using the procedure codes listed for the Home EPIV Services fee schedule and supplemental materials. [Publications: Publications referenced are available from the agency.]