Traditional Medicare and MA rules are mixed together
Your team needs separate workflows for Original Medicare and Medicare Advantage plans, especially around authorization, appeals, and payer portals.
Medicare Part A, B, C & D Billing Services
Medicare billing built for clean claims, payer rules, and compliance pressure.
Medicare billing is not one workflow. Facility claims, physician services, Medicare Advantage plans, and drug-related coverage all follow different rules. B3CARE helps your practice identify the right Medicare path, submit cleaner claims, and respond quickly when payers request more documentation.
Part A, Part B, Part C, and drug-related billing support
CMS, MAC, LCD, and NCD-aware claim workflows
Medicare Advantage authorization and denial support
ABN, MSP, COB, and documentation controls
Why Medicare Claims Break
The problem is rarely just a code. It is usually the wrong rule applied at the wrong time.
Claims deny after medical necessity review
We check LCD/NCD policy, diagnosis support, modifiers, and documentation before submission and use the same evidence when appeals are needed.
Drug billing crosses benefit lines
Administered drugs can require J-codes, NDC detail, prior authorization, and Part B vs. Part D review depending on the payer and setting.
Part A, B, C & D Support
Medicare billing organized by benefit, claim type, and payer behavior.
B3CARE does not force every Medicare claim into the same process. We separate facility, professional, Medicare Advantage, and drug-related workflows so claim submission and follow-up match the actual payer requirement.
Medicare Part A
Inpatient and Facility Billing
UB-04 / CMS-1450 workflows
Support for facility-based Medicare billing where revenue codes, occurrence codes, condition codes, DRG logic, and documentation timing all affect payment.
Inpatient hospital claim support
Skilled nursing facility PPS billing coordination
Hospice billing, NOE filing, and election statement review
Home health episode billing and OASIS-aware support
Critical Access Hospital billing and cost report support
Medicare Part B
Physician and Outpatient Billing
CMS-1500 / professional claim workflows
Part B is the daily Medicare billing engine for most physician practices. B3CARE helps keep coding, modifiers, medical necessity, and payer response handling aligned.
E/M, procedure, diagnostic, and consultation claim support
Preventive service billing, including AWVs and screenings
DME documentation checks, including CMN-related requirements
CCM, RPM, and care management billing support
Global surgery period and modifier review
Medicare Part C
Medicare Advantage Billing
Private MA plan workflows
Medicare Advantage claims require plan-specific rules for authorization, claim routing, appeal levels, fee schedules, and documentation. We treat every MA payer as its own playbook.
MA plan credentialing and contract review support
Prior authorization tracking before service
Plan-specific claim submission and status monitoring
Medicare Advantage denial appeals and escalation
HCC coding support for value-based MA arrangements
Medicare Part D
Drug Coverage and Billing Coordination
Drug benefit and provider-administered drug support
Part D is usually processed through pharmacy benefit channels, but provider-administered drugs often require careful Part B vs. Part D review by setting, drug, payer rule, and documentation.
Part B vs. Part D coverage path review
J-code, NDC, and HCPCS Level II support for administered drugs
Oncology, infusion, injection, and vaccine billing coordination
Prior authorization and medical necessity documentation support
Patient responsibility and secondary coverage review
CMS Compliance Controls
Safeguards that protect claims before they become denials.
Medicare reimbursement depends on what happened before the claim was submitted: eligibility, coverage policy, ABN handling, documentation, payer order, and authorization where applicable.
LCD and NCD coverage checks
Coverage policy is reviewed before submission so diagnosis codes, service frequency, and documentation support medical necessity.
MAC jurisdiction handling
Medicare Administrative Contractor rules can vary by region. We align claim edits, policy checks, and follow-up to the correct jurisdiction.
ABN workflow guidance
When a service may not be covered, B3CARE helps practices identify where Advance Beneficiary Notice workflows should happen before care is delivered.
MSP and COB review
Medicare Secondary Payer and coordination-of-benefits issues are checked so claims route to the right payer in the right order.
Medicare Advantage authorization control
For Part C plans, we help track authorization status, plan-specific evidence requirements, and appeal deadlines.
HIPAA-secure revenue cycle operations
Claim data, eligibility details, payer responses, and reports are handled through secure operational workflows.
Medicare Claim Workflow
A practical workflow your billing team can measure.
Every Medicare claim needs a path, a policy check, a clean claim submission, and a follow-up owner. B3CARE keeps those steps connected from intake through payment posting.
Identify the Medicare path
Confirm whether the claim belongs under Part A, Part B, Medicare Advantage, or drug-related coverage coordination.
Validate coverage and documentation
Review LCD/NCD rules, diagnosis support, ABN need, authorization status, MSP details, and service-specific documentation.
Submit clean claims
Prepare the correct professional, facility, or MA claim workflow with required codes, modifiers, revenue codes, NDCs, or attachments.
Track, post, and appeal
Monitor payer response, post ERA/EOB activity, appeal denials with evidence, and report root causes back to your team.
Connected Services
Medicare performance improves when enrollment, billing, and denials are not separated.
Medicare FAQs
Common Medicare billing questions from providers.
Do physicians mostly bill Medicare Part B?+
Yes. Most physician services, outpatient professional services, preventive care, diagnostic services, and many procedures are billed under Medicare Part B. B3CARE supports CMS-1500 professional claim workflows, coding review, modifier checks, payment posting, and Part B denial follow-up.
How is Medicare Advantage billing different from traditional Medicare?+
Medicare Advantage is administered by private plans. These plans may have their own prior authorization rules, payer portals, fee schedules, claim edits, and appeal pathways. B3CARE separates Medicare Advantage workflows from traditional Medicare so plan-specific requirements are not missed.
Can B3CARE help with LCD, NCD, and medical necessity denials?+
Yes. B3CARE reviews coverage policies before claim submission and uses clinical documentation, diagnosis support, proof of authorization, ABN information, and payer correspondence when a medical necessity denial needs to be appealed.
Does B3CARE handle Part D pharmacy claims?+
B3CARE is not a retail pharmacy claims processor. Our Part D-related support focuses on provider workflows where drug coverage questions affect medical billing, such as provider-administered drugs, injections, infusions, vaccines, prior authorization, and Part B vs. Part D coverage review.
Medicare Billing Consultation
Medicare billing does not have to slow down your revenue cycle.
Let B3CARE review your Medicare billing workflow, denial patterns, documentation gaps, and payer-specific follow-up process.