Medicare Part C/Advantage Plans  FAQs Q: I have a Medicare Advantage patient who is a QMB; do the billing requirements apply to these patients?  A: The QMB billing restrictions apply to all QMB patients including Medicare Advantage beneficiaries. Q: Should I use the Medicare Mandatory ABN for Medicare Advantage Plans?  A: According to CMS‚ “You…

Download Support Tools We recommend that you create a folder in your clinic’s billing compliance manual that is dedicated to Medicare Advantage Part C resources. We have included several for your consideration. Some are payer examples of specific forms mentioned in this training. Use it as a reference point for your online search for similar…

Know the Rules Providers who have mastered the rules and regulations surrounding traditional Medicare are often surprised to find that Medicare Advantage plans have their own set of rules. These are not optional. It is vital that a clinic locates these resources and requirements on each payer’s provider portal. We have listed some of these…

Download Support Tools Medicare Advantage (MA) Verification Form Master Template

Data That Leads to Reimbursement By building a solid data collection and verification process, a clinic can increase reimbursement and reduce frustration. This tutorial will walk you through the ins and outs of gathering information that will assist the clinic in submitting clean, payable claims. You may think that verification is too time consuming but…

Know the Rules Once you obtain a copy of the patient’s Medicare Advantage card there are two things you need to give attention to when verifying coverage: Is the Medicare Advantage (MA) Plan a Private Fee for Service (PFFS) plan? Usually listed on the front of the card. If not, ask when you verify. Are…