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…
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Medicaid provides health coverage to around 80 million Americans including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is administered by the states in accordance with federal requirements. State and Federal Governments fund the program jointly. The Rapid Tutorial titled What is Medicaid provides an overview of the basics of…
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Medicare Collections FAQs Q: Can we offer Medicare patients our time-of-service discounted fees? A: A reasonable time-of-service discount on services that are patient responsibility doesn’t violate any regulation depending on the amount of the discount, how your policy reads, and other factors. For example, that would include statutorily non-covered services and maintenance care for which…
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Excluded Services in Medicare FAQs Q: According to Medicare, what is considered a statutorily excluded service when rendered by a Doctor of Chiropractic? A: A statutorily excluded service is a service the Medicare never covers when it is rendered by a Doctor of Chiropractic. This includes exams, x-rays, and physical therapy. The only service always…
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This tutorial discusses an important compliance related topic that impacts all clinics that accept and treat Medicare beneficiaries. Sadly, in most clinics, the requirements surrounding a Qualified Medicare Beneficiary (QMB) is often ignored resulting in serious violations of Medicare regulations.
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It’s important to understand the difference between true verification and an eligibility check. There are so many layers to understanding the coverage a Medicare patient has that you must follow each step methodically. Whether the patient has Medicare Part B or Medicare Part C is the first critical bit of information you must be aware…
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