Author Topic: Medicare replacements  (Read 2700 times)

QueenAlicia

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Medicare replacements
« on: December 30, 2012, 04:50:28 PM »
I have a new client that is Chiro and has a lot of Medicare replacements. I have limited view of their software as I am using their Practice Mate system.  I have to go to the patient visits to look to see of they have secondary insurance to either submit secondary claims.  Now, to the question, is there a list of medicare replacements out there to use to help to know when I am billing Medicare or United Healthcare or another insurance ?

I think she expects me to know already and read minds because I see UHC on the insurance and not Medicare when I bill causing the claim to not be paid. She won't let me know what the replacements are.

Any help with figuring out the medicare replacements?

RichardP

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Re: Medicare replacements
« Reply #1 on: January 02, 2013, 03:45:28 AM »
I assume you know that Medicare forwards claim info to many secondary insurance carriers.  We do very little secondary billing on our Medicare patients because of this.  But the secondary insurance needs to be in the database (for us anyway) for purposes of posting payments received from that secondary. 

We get paid a percent of all monies collected.  If the doctor doesn't get paid, neither do we.  Therefore, our client agreement emphasizes that the client must provide us with all information that we need to get them paid.  For new patients, and for established patients who have changed either address or insurance, the client must provide to us copies of the demographic and insurance information.  The client's office enters that data into the database.  But if it is wrong, we won't get paid.  Therefore, we use the info they provide us on new patients to verify that the information in the database is correct.  We correct the info ourselves if it is incorrect.  Staff turnover amongst our clients is high enough to make doing this cheaper for us than constantly spending our time to train and re-train our clients' staff.

You might gently but firmly insist on a similar set-up with your clients.  As you've just demonstrated with your post, if you don't have all the information you need to get your client paid, he won't get paid.  The client should understand that logic.
« Last Edit: January 02, 2013, 04:01:31 AM by RichardP »

PMRNC

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Re: Medicare replacements
« Reply #2 on: January 02, 2013, 01:31:44 PM »
Quote
I assume you know that Medicare forwards claim info to many secondary insurance carriers.  We do very little secondary billing on our Medicare patients because of this.  But the secondary insurance needs to be in the database (for us anyway) for purposes of posting payments received from that secondary.

Medicare replacement plans are NOT secondaries. Basically it is Medicare Part C, and a patient MUST have Part A and B. If they are "eligible" for A and B, they can have Part C and it's provided via various commercial carriers. When Part C is active, parts A and B are INACTIVE since C will cover BOTH medical and hospital benefits. With Part C the benefit can often be lower out of pocket with options added such as pharmacy, dental, vision etc not normally covered by Medicare A/B. The exception I believe is Hospice Care which is not covered through a Medicare Replacement plan (part c)

 Now, not to mince words but it's important, are you speaking of Medicare Secondaries, Replacements (as explained above) or Supplemental. They are all different.   With Medicare Replacement plans you will treat that plan like another commercial and verify benefits with that carrier, you may not even know it's a Medicare Replacement unless the ID card says it. I've seen some that say actual "PART C coverage" and I've seen others say "Medicare Replacement".  Important regardless to get the ID card and verify benefits as you would all other patients with their carrier.
Linda Walker
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RichardP

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Re: Medicare replacements
« Reply #3 on: January 02, 2013, 10:06:42 PM »
I did not intend to equate secondaries (or primaries) with Medicare replacement plans.  I was just trying to cover all the bases with QueenAlicia.  Regardless of what Medicare replacement plans might be (or how she might be defining them), she needs to be able to see a copy of all current insurance cards so she can verify that the info in the dbase is correct - as I laid out above. :)

At any rate, to answer QueenAlicia's question, try this link.  The plans available vary by state.

http://www.longtermcarelink.net/eldercare/ref_list_medicare_advantage_standalone_PDP.htm

This link might be of use to somebody, so I'll include it also:

http://www.q1medicare.com/PartD-SearchMA-Medicare-2013PlanFinder.php
« Last Edit: January 02, 2013, 10:33:52 PM by RichardP »

QueenAlicia

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Re: Medicare replacements
« Reply #4 on: January 16, 2013, 05:25:26 PM »
Quote
I assume you know that Medicare forwards claim info to many secondary insurance carriers.  We do very little secondary billing on our Medicare patients because of this.  But the secondary insurance needs to be in the database (for us anyway) for purposes of posting payments received from that secondary.



 Now, not to mince words but it's important, are you speaking of Medicare Secondaries, Replacements (as explained above) or Supplemental. They are all different.   With Medicare Replacement plans you will treat that plan like another commercial and verify benefits with that carrier, you may not even know it's a Medicare Replacement unless the ID card says it. I've seen some that say actual "PART C coverage" and I've seen others say "Medicare Replacement".  Important regardless to get the ID card and verify benefits as you would all other patients with their carrier.


From what I know if the patient does not let Medicare know that they have a secondary it will not automatically forward to the secondary.  I have been seeing this the past few months with one of my providers patients.


Yes, Linda, this is what I meant.  For example United Healthcare was the replacement but in the patients demo's it stated Medicare and did not say UHC was the replacement causing it to be submitted without the AT modifier.  When I spoke to the provider she had the attitude as if I was supposed to know.  I asked " are there a lot of your patients with medicare replacements?" and  she says that there are a lot".  I was thinking you may want to let me know now what the medicare replacements are so that this does not happen again. 

PMRNC

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Re: Medicare replacements
« Reply #5 on: January 17, 2013, 09:52:32 AM »
Quote
Yes, Linda, this is what I meant.  For example United Healthcare was the replacement but in the patients demo's it stated Medicare and did not say UHC was the replacement causing it to be submitted without the AT modifier.  When I spoke to the provider she had the attitude as if I was supposed to know.  I asked " are there a lot of your patients with medicare replacements?" and  she says that there are a lot".  I was thinking you may want to let me know now what the medicare replacements are so that this does not happen again. 

Ok, just be SURE she means they are actual "replacements"like I said there is a difference.. You want to check that because really there shouldn't be A LOT. Replacements have not taken off the way CMS wanted. There are far more supplemental secondary to Medicare's than anything.  With that said, SOME of the patient's ID cards will say either Medicare Replacement, or Medicare Part C somewhere ON the card. I just came across one where on the BACK of the card it said "For benefit verification of Part C coverage call ----"  I wouldn't have known if I didn't look at the copy of the BACK of the card.   I do all my clients verifications, it's my own control thing that allows me to make sure these are all in order. My office managers in my clients offices do the "pre screening" It goes like this.   Receptionist or OM makes the appt, if it's a new patient, they have a pre-screening form they use to gather all of the information i need to verify benefits. That gets faxed to me and I verify benefits.   IT is very rare that I run into these problems from doing it this way, plus I don't have to worry about the staff missing something, it would be on me. Bottom line the only way to really prevent things like that is to be vigilant with verifications.
Linda Walker
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www.billerswebsite.com

DMK

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Re: Medicare replacements
« Reply #6 on: January 17, 2013, 10:29:02 AM »
And from a front office standpoint, many Medicare patients DON'T EVEN KNOW if their plan is a replacement plan.  That's what makes Medicare patient's so tough, they often can't keep track of the changes in their plans each year.

Linda is absolutely correct, someone needs to verify what kind of plan it is 1st thing.  That way you don't have to wait until Medicare tells you that you billed it to the wrong vendor.  I'm guilty of having this happen several times each year.  (Thanks for the Part C info Linda!)

QueenAlicia

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Re: Medicare replacements
« Reply #7 on: January 17, 2013, 01:24:11 PM »
See, here is the thing, I DON'T authorize  benefits for them.  This is a fairly easy account really, they send the day sheets and their schedule and I submit claims, post payments, statements in their system.  Their OM verifies insurance and when it states medicare in the insurance column it does not state "replacement".  I don't even  see the insurance cards or anything.  So I started looking at the age of the patient to determine the use of the modifier so I know won't have the denials.

PMRNC

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Re: Medicare replacements
« Reply #8 on: January 17, 2013, 01:28:40 PM »

Quote
See, here is the thing, I DON'T authorize  benefits for them.  This is a fairly easy account really, they send the day sheets and their schedule and I submit claims, post payments, statements in their system.  Their OM verifies insurance and when it states medicare in the insurance column it does not state "replacement".  I don't even  see the insurance cards or anything.  So I started looking at the age of the patient to determine the use of the modifier so I know won't have the denials.

Do you mind if I ask are you billing them a %? If so it's to your benefit to take over this duty, if it's not or not included in your services your charging for, perhaps you can suggest adding it (at cost of course) and be sure they realize the importance of the task and how essential it is in the reimbursement process. they will be either TOO happy to let you do it OR get busy themselves and make sure they do it, Only one of those two are going to ensure proper reimbursement.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

dekenn

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Re: Medicare replacements
« Reply #9 on: January 17, 2013, 07:26:52 PM »
Just an FYI, at least with our Medicare contractor (Novitas), (and I would guess they all have it), there is a phone number that you can call that will tell you if they're Medicare eligible, and if so, if they have a different Medicare plan. You would have to know the doctor's NPI and PTAN though, to access the info, but it is an easy way to find out what they actually have.

QueenAlicia

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Re: Medicare replacements
« Reply #10 on: January 18, 2013, 12:11:49 PM »

Quote
See, here is the thing, I DON'T authorize  benefits for them.  This is a fairly easy account really, they send the day sheets and their schedule and I submit claims, post payments, statements in their system.  Their OM verifies insurance and when it states medicare in the insurance column it does not state "replacement".  I don't even  see the insurance cards or anything.  So I started looking at the age of the patient to determine the use of the modifier so I know won't have the denials.

Do you mind if I ask are you billing them a %? If so it's to your benefit to take over this duty, if it's not or not included in your services your charging for, perhaps you can suggest adding it (at cost of course) and be sure they realize the importance of the task and how essential it is in the reimbursement process. they will be either TOO happy to let you do it OR get busy themselves and make sure they do it, Only one of those two are going to ensure proper reimbursement.

Yes, she is my ONLY client on this type of payment.  I hate it and she really is a PIA that likes to micro manage.  I really don't thin that she understands how a billing service works.  They go in and post a check payment and then send the EOB's to me and I apply that check to the visits.  Everything is backwards and I just deal with her in a way that causes me less stress.