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The End of the Public Health Emergency: Part 3 – Medicaid DIS-Enrollments

The Consolidated Appropriations Act of 2023, signed by President Biden on December 29, 2022, ends the continuous health coverage requirement for Medicaid members during the public health emergency. While this requirement was in place, Medicaid members did not have to go through the usual annual redetermination of their eligibility for benefits. However, now that this requirement has ended, Medicaid members will receive renewal letters with requests for information. If they do not respond or respond late, they could lose their Medicaid coverage.

States could start this process as early as February 2023, and disenrollment may start on April 1, 2023. This means that some Medicaid members may lose their coverage starting in May 2023. However, many states have opted for an “unwinding” period over the course of twelve months. During this period, Medicaid members who do not respond to renewal letters or requests for information may lose their benefits.

The potential for Medicaid members to lose their coverage could have a significant impact on providers with a high concentration of Medicaid members. Providers may see a negative impact on their cash flow and need to have conversations with patients to encourage compliance with requests for information to avoid disenrollment. Additionally, contingency plans should be in place to ensure payment for future visits. This could include setting a cash-pay or sliding fee policy, providing assistance or information about the plans available on the Marketplace, completing any paperwork required for patients during the redetermination phase, and being available to support an appeal if necessary.

To avoid surprises and non-payment, providers should verify eligibility on all patients. According to the Kaiser Family Foundation, between 5 million and 10 million people will lose their Medicaid coverage as states re-start the redetermination phase. Providers should be prepared for a potential increase in uninsured patients and have plans in place to ensure they are still able to provide quality care to those in need.

The end of the public health emergency marks a new phase in the healthcare landscape. With the end of the continuous health coverage requirement for Medicaid members, providers must be proactive in ensuring their patients have the necessary information to maintain their coverage. This includes having conversations with patients, verifying eligibility, and having contingency plans in place to ensure payment for future visits. By doing so, providers can continue to provide quality care to all patients, regardless of their insurance status.

With our deep expertise in healthcare policy, reimbursement, and regulatory compliance, PractiSynergy has been guiding our clients through the complex and dynamic changes that have arisen with the conclusion of the PHE.  Contact PractiSynergy at Practisynergy.com/contact-us/ to learn how to protect your cash flow through these upcoming changes.

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End of Public Health Emergency – Part 2

As the end of the public health emergency (PHE) approaches, it’s important for medical billing and coding businesses like PractiSynergy to stay up-to-date on the latest developments in telehealth services. During the PHE, the US Department of Health and Human Services made significant changes to the requirements for patients to access and for medical professionals to provide telehealth services.

Thanks to the Centers for Medicare and Medicaid Services (CMS) enacting waivers, providers were given greater flexibility in using telehealth services for their patients. But what happens when the PHE ends? In December 2022, President Biden signed the Consolidated Appropriations Act which extended the telehealth waivers through December 31, 2024. This means that the following temporary benefits will still be in effect:

  • No geographic restrictions on telehealth originating sites, including in a patient’s home
  • Telehealth visits may be delivered using audio/video or audio-only platforms
  • In-patient visits will not be required within a certain timeframe of a telehealth visit for mental/behavioral health
  • Physical and Occupational Therapists, Speech Language Pathologists, and audiologists may offer telehealth services
  • Services may be rendered outside of a provider’s state of enrollment
  • Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC) can serve as a distant site provider for non-behavioral/mental telehealth services.

However, it’s important to note that one element of the PHE telehealth service will end with the end of the PHE. Providers will now be required to use HIPAA-secure means of communication platforms while providing services. This means CMS will no longer allow chat applications such as FaceTime, Google Hangouts, WhatsApp video chat, etc. as a method to communicate with patients.

It’s essential to stay current on these changes to telehealth services. By doing so, providers can continue to offer high-quality care to their patients in a way that’s safe, secure, and compliant with all applicable regulations. At PractiSynergy, we’re committed to helping our clients navigate these changes and stay ahead of the curve when it comes to telehealth services.

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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.