How Will I Know Whether To Bill Medicare Part B Or Part D?

Patients seldom wonder about which Medicare plan to bill. Part A covers any hospitalization that might be necessary, Part B handles medical testing and Part D handles drugs. Sometimes a certain drug may be required for testing, or a medical receptionist may not be sure how to works.

As a General Rule

Medicare Part B covers drugs that must be administered by what is known as durable medical equipment. This includes inhalers, nebulizers, and oxygen. Part B will cover this under most circumstances, but only if the patient uses the drugs in his own home. Medicare Part B and Part D make differentiate between pills and other types of medication

When Not to Bill Medicare Part B and D

If a drug was administered as part of a hospital stay or administered as result of a transplant whose cost is covered under Medicare Part A, a hospital will bill the first part and leave the B and D premiums alone. This is the only time when few ambiguities arise.

Nursing Homes and Billing Medicare Part B or D

Nursing home are not considered a patient’s primary residence for determining Medicaid billing purposes. Even items that would normally be covered under Medicare Part D would be covered under Part B instead. This is true even if a person is confined to a nursing home and is not expected to make a full recovery.

Pharmacies find that they need to figure out whether to bill Medicare Part B or Part D most frequently. Physicians can help the pharmacist by providing a detailed drug plan for patients that the physician refers to the pharmacist. Having the plan at least saves the pharmacy employees some unnecessary paperwork. It can also save the prescribing physician from receiving a phone call from a drug store asking for clarification.

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