Author Topic: TAKING MCR MANAGED CARE FOR EXISTING PATIENTS  (Read 2251 times)

ellie

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TAKING MCR MANAGED CARE FOR EXISTING PATIENTS
« on: January 26, 2014, 11:28:42 AM »
We are not contracted with any MCR managed cares. We do however, take MCR traditional card, red/white/blue. The doctor says that if he has an existing patient who has a mcr managed care, he will see them, if a new patient he won't.

I find this alittle troublesome, as a biller.

I don't think he can do this, need your advice.

Thank you

Merry

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Re: TAKING MCR MANAGED CARE FOR EXISTING PATIENTS
« Reply #1 on: January 26, 2014, 12:08:20 PM »
But he cannot bill the Advantage Plan, Medicare or the patient. Is he aware of that?

PMRNC

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Re: TAKING MCR MANAGED CARE FOR EXISTING PATIENTS
« Reply #2 on: January 26, 2014, 01:07:01 PM »
Quote
We are not contracted with any MCR managed cares. We do however, take MCR traditional card, red/white/blue. The doctor says that if he has an existing patient who has a mcr managed care, he will see them, if a new patient he won't.

A physician is INDEED allowed to decide NOT to take on new patients (Medicare or otherwise) This is an alternative many providers went with rather than opting out where they would need to stop seeing their current Medicare patients. The only thing they have to do is keep in consistent, no bending the rules for one over another.
Linda Walker
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ellie

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Re: TAKING MCR MANAGED CARE FOR EXISTING PATIENTS
« Reply #3 on: January 26, 2014, 07:58:12 PM »
I agree, He cannot not bill and/or decide one over the other. He either does or he doesn't, in my case as a biller, I always say no !!!!!!!!!!!

Michele

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Re: TAKING MCR MANAGED CARE FOR EXISTING PATIENTS
« Reply #4 on: January 27, 2014, 09:36:01 AM »
He can keep his existing patients but not accept new patients in those plans but the problem is that he may not be in network with the managed care plans so as Merry said he wouldn't be able to bill the patients.  But as long as his policy is "accept existing patients with a change of payer" that is ok.
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PMRNC

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Re: TAKING MCR MANAGED CARE FOR EXISTING PATIENTS
« Reply #5 on: January 29, 2014, 01:46:35 PM »

Quote
He can keep his existing patients but not accept new patients in those plans but the problem is that he may not be in network with the managed care plans so as Merry said he wouldn't be able to bill the patients.  But as long as his policy is "accept existing patients with a change of payer" that is ok.

IF the provider gives notice, they can refuse to see new patients in a particular plan, par or not. For example, if an EXISTING patient has UHC but they change to BCBS and provider has policy not to accept new patients under BCBS, they would really have no choice to take the patient but they could provide the patient with notice (according to any contract and dismissal laws). If the provider is NON par with BCBS they have right to ask for the payment up front, notice or not.

Linda Walker
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Christy

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Re: TAKING MCR MANAGED CARE FOR EXISTING PATIENTS
« Reply #6 on: February 10, 2014, 04:31:20 PM »
confused? If a patient is coming in with straight Medicare and all of a sudden switches to managed Medicare without informing the office (happens all the time), what if the office is not in network with a managed Medicare HMO....

the patient still cannot be billed??!? :(

Merry

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Re: TAKING MCR MANAGED CARE FOR EXISTING PATIENTS
« Reply #7 on: February 10, 2014, 08:56:37 PM »
The patient should ALWAYS be asked at each visit if the information on file is still current. If the patient changes over to an Advantage Plan and has not informed the office so that the office can inform them that they are not part of that Advantage network, the patient can absolutely  be billed. That would be misrepresentation on the part of the patient even if the office did not ask.

I think it is always good policy to ask the patient each time. Sounds like extra work but a practice can do it quickly, just confirming that the info on file is up to date. No extra paperwork.

In the "old days" we would check once a year, in the beginning of each year, but nowadays, with plans changing and employers always looking for "cheaper plans", the changes can happen anytime. Always ask. Good policy.

PMRNC

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Re: TAKING MCR MANAGED CARE FOR EXISTING PATIENTS
« Reply #8 on: February 11, 2014, 09:16:04 AM »
Quote
confused? If a patient is coming in with straight Medicare and all of a sudden switches to managed Medicare without informing the office (happens all the time), what if the office is not in network with a managed Medicare HMO....

If your provider does not par with that HMO the patient should be told this so they can make a decision to go to a provider in their Medicare HMO or they have to pay up front if that's the doctors policy.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com