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What You Need to Know About Medicare Open Enrollment

For those who are Medicare-eligible, now through December 15th is the time to look into open enrollment options. Today we’ll look at the two main options available–Medicare Part B and Medicare Advantage plans–and weigh the differences and costs. In the past, providers only needed to participate in Medicare to see Medicare beneficiaries. With the addition of Medicare Advantage Plans, providers need contracts with several insurance companies to see patients they have already been seeing for years in order to get paid. It’s important to know what this means for your practice and your patients.

Medicare Part B

What does it cover? How is it different?

Administration

  • Medicare Part B is administered through the Social Security Administration.

Services

  • Outpatient services: annual well-patient visits, some vaccines, physical rehabilitation, etc.
  • Non-hospital medical services like physical therapy, occupational therapy, and office visits
  • Ambulance services
  • Mental health services

Equipment

  • Durable medical equipment
What are the costs?
  • Monthly premium depending on income
  • $226 deductible for ALL Medicare Part B beneficiaries in 2023
  • 20% co-insurance applies to each covered service with no maximum out of pocket
  • Physician referral may be required for payment of services
  • No-cost annual physicals, certain vaccines, and certain lab services
  • Does not cover prescription drugs (for this coverage, patient must also enroll in Medicare Part D)
  • Many patients add supplemental Medicare coverage (secondary insurance) to ease patient responsibilities, but also require additional monthly premiums
  • Medicare sets the allowable fee schedule used by many carriers

 

Medicare Advantage

Advantage Plans replace the patient’s Medicare Policy and add complexity to the care of patients.

What does it cover? How is it different?

Administration

  • Medicare Advantage is administered through private insurance companies abiding by Medicare coverage policies
  • Medicare Advantage plans can provide expanded coverage by combining Medicare Part A and Part B in one plan
  • May require prior authorizations for payment of service (Medicare Part B does not require prior authorizations)
  • Providers must be contracted with Advantage Plans for coverage and payment of service

Services:

  • Some plans offer additional benefits such as dental, vision, hearing, wellness benefits, and others
  • Includes prescription drug coverage
  • Limited network of contracted providers
  • Any services covered by Medicare are covered by Advantage plans
  • Advantage Plans may limit frequencies of service (physical therapy, in-network referrals, etc.)

What are the costs?

  • Monthly premium–differs based on plan options, benefits, and income
  • Deductible varies by plan
  • Co-pays and co-insurance–these vary depending on type of medical service
  • Limitations on out-of-pocket expenses–deductible, co-insurance, and copays
  • Providers bear the burden of collecting out of pocket expense–supplemental plans can not be used to pay Medicare Advantage copays, deductibles, or premiums

For the good of your patients and your practice, it’s crucial to communicate with patients and let them know who you are contracted with. Most insurance companies take many months to get providers added to networks, so don’t let your patients be left behind. You can relieve the burden of your administrative staff and ensure a satisfactory patient experience by working with PractiSynergy to handle your medical credentialing and billing.

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Medical Billing Guide

Am I being Scammed? – The Truth Behind Virtual Credit Cards

Did you get a piece of paper in the mail with what appears to be an outline of a credit card with numbers and a whole bit? What are these and are they legit? 

It’s no secret the internet is slowly taking over. Everything is becoming ‘optimized & automated’. After COVID, the virtual world skyrocketed as we know it. It’s no surprise credit card companies have wanted an in. These virtual credit cards advertise as a streamlined way to make purchases and keep up with payments. Much like everything else, virtuality has its pitfalls. Not everything is meant to be optimized. Have you ever been on the phone with a large company, needing assistance, but find it takes an endless amount of time to reach an actual person? Virtual robots can’t assist you the way human interaction can. 

Providers are getting buried in a sea of virtual credit cards coming from all different insurance companies – companies as large as UnitedHealthcare to small private union insurance funds. The appeal behind these virtual cards can be rooted within streamlining the process. Insurers are trying to reduce costs by outsourcing payment processing. Printing checks requires supply costs as well as people to print and handle these checks. The downfall of checks include getting lost mail. The advantage of virtual credit cards means it’s easier to track. Since the credit card isn’t tangible, the balance can’t get lost. 

Each insurer has different needs. Providers must figure out what is the best option for them – virtual credit cards, physical checks or direct deposits. All fees need to be examined as well as the time it may take if checks get lost. Some corporations find it beneficial to outsource to virtual assistance – saving them time to get back to their main job duties. The right virtual credit card can also help protect personal information and privacy. Virtual cards generate new card numbers, so that individual account numbers can stay confidential. 

Providers get dinged with fees since they have to run the cards through a merchant service provider (credit card servicer) that will deposit the funds into their bank account. If you decide a virtual credit card is not your jam. You must initial the “opt-out” of these cards and select check or direct deposit. Keep in mind some of the direct deposit options through these outsourced vendors also charge a fee.

All in all, there’s a give and take between payment options. Each individual requires different needs. And it’s important to seek counsel when choosing the best option. At PractiSynergy, we work closely with clients to give them the best option for their unique needs. To get informed about our medical coding and billing services, reach out to Katie Fergus. Call 515.412.2800 or email  katie@practisynergy.com.