BILLING NEWS

Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody under a Penal Authority and Examples of Application of Government Entity Exclusion

This article is based on Change Request (CR) 6544, which describes special conditions that must be met in order for Medicare to make payment for services provided to individuals or groups of individuals who are in the custody of the police or other penal authorities or in the custody of a government agency under a penal statute or rule. This CR instructs Medicare contractors that "payment may be made for services furnished to individuals or groups of individuals who are in the custody of the police or other penal authorities or in the custody of a government agency under a penal statute only if the following conditions are met:

  1. State or local law requires those individuals or groups of individuals to repay the cost of medical services they receive while in custody, and
  2. The State or local government entity enforces the requirement to pay by billing all such individuals, whether or not covered by Medicare or any other health insurance, and by pursuing the collection of the amounts they owe in the same way and with the same vigor that it pursues the collection of other debts."

Providers and suppliers are reminded that if they render services or items to a prisoner or patient in a jurisdiction that meets these conditions they are to include modifier QJ on claims submitted to carriers, A/B MACs or use condition code 63 on institutional claims sent to Medicare FIs or A/B MACs.


SOURCE: Source
INDUSTRY NEWS TAGS: CMS


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