Important Facts about MA Plans Although a Medicare Advantage (MA) plan is technically a form of Medicare coverage, it is best to view these plans similarly to your contracted commercial payers. Advantage Plans often follow the same billing rules as regular commercial carriers. If you are a contracted provider for the plan the patient belongs…

The Replacement Plan Challenge With the introduction of Medicare Advantage (MA) Plans, team members must be diligent about asking Medicare beneficiaries for copies of all insurance cards. Often a patient will provide their traditional Medicare card to the office even though they have opted to replace their coverage with a Medicare Advantage plan. If your…

Confirming QMB Status Medicare Qualified Beneficiaries (QMBs) hold special status when it comes to cost sharing in your office. It’s important to identify them carefully before any financial transactions take place. In 2017 CMS set up a system to help clinics and clearinghouses verify status. The system is called the HIPAA Eligibility Transaction System (HETS)….

Types of QMBs The Medicare Savings Programs (MSPs) was developed to assist low-income Medicare beneficiaries. Individuals who qualify for this assistance are often referred to as Dual Eligibles. All dual-eligible beneficiaries qualify for full Medicare benefits, but the extent or level of benefits for which they are eligible under Medicaid can vary. This is often…

The Qualified Medicare Beneficiary This short training provides an overview of the concept of QMB. These patients are entitled to different rules within the Medicare process and the collection of copayments and deductibles. It’s an area where a misstep can lead to major compliance issues. Make sure all team members are aware of this important…

Medicare benefits are administered directly by the government, whereas Medicare Advantage (MA) plans are managed by commercial or private plans. When navigating the world of Medicare Advantage plans it is vital that your front desk, billing and treating doctors have a solid understanding of the many aspects of regulatory compliance that surrounds these plans. In…