Insurance companies are blanketing the airwaves with commercials enticing Medicare beneficiaries to leave fee-for-service coverage for Medicare Advantage plans in 2021. They promise to save money and offer additional benefits like gym memberships, transportation, and coverage for drugs, dentists, hearing aids, and more.
But, it’s not sunshine and daisies for everyone …
Unanticipated insurance changes disrupt cash flow. Plan switching in-between resupply intervals or during active rentals is particularly difficult for HME suppliers. Fortunately, proactive organizations need not wait for a denial to take action and preserve the revenue cycle.
But, it’s not sunshine and daisies for everyone …
Unanticipated insurance changes disrupt cash flow. Plan switching in-between resupply intervals or during active rentals is particularly difficult for HME suppliers. Fortunately, proactive organizations need not wait for a denial to take action and preserve the revenue cycle.
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Suppliers can Identify Medicare Patients Changing to Advantage Plans Before the Switch!
Suppliers can use Medicare eligibility tools available in the myCGS and Noridian Medicare Portals, as well as many billing software applications, to determine which Medicare patients are changing to Medicare Advantage before the switch occurs! By entering a future date of service for the check, the eligibility search will return the insurance details effective next year.
By checking 2021 eligibility in December for Medicare patients, especially those with recurring rentals that may not have direct interaction with staff, suppliers can proactively secure the medical documentation necessary to continue the billing cycle. Waiting until the inevitable January denial is certain to depress cash flows and increase strain on the billing department.
Engage Patients Directly
Every patient interaction from now until January is an opportunity to identify insurance changes and preserve cash flows with less effort. With every patient call, customer service personnel should consistently perform a future eligibility check and ask about changes to insurance coverage.
Moreover, suppliers can include colored flyers with patient statements to notify customers of the need to alert the billing department of any upcoming insurance policy changes. Use the opportunity to remind customers that new insurance may require:
Suppliers should also evaluate new and existing plans in which they participate. Plan offerings change; those with previously closed networks may once again accept new providers. However, suppliers must have a clear understanding of the fit and fitness of a plan before agreeing to participate. Above all, efficient organizations must actively educate employees and customers on which local plans they accept. Planning and clarity allow suppliers to keep the patients they can and help the others with unsustainable coverage move on.
To start, suppliers can use the Medicare find-a-plan website to take stock of which Advantage plans operate within their service area. To use the tool:
This year, a new Part D and Medicare Advantage benefit is likely to increase the number of patients changing insurance. Hundreds of plans permit diabetic patients to pay a flat $35/month co-pay for insulin, regardless of unmet deductibles or phase of coverage. CMS advertises the benefit will save the average senior $446 annually.
Because the cash flow disruption could be worse than usual, suppliers have one more reason to proactively verify eligibility for Medicare customers before the end of the year. Carve out dedicated time now to communicate with patients, perform eligibility checks, and follow through with necessary insurance coordination between the patient, doctor, and insurance carrier. Doing so will prevent unnecessary denials and decreased profits.
SOURCE LINKS
https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Medicare-Open-Enrollment-Print-Ad.pdf
https://www.cms.gov/files/document/insulin-costs-beneficiaries-infographic.pdf
https://www.cms.gov/newsroom/press-releases/cms-launches-groundbreaking-model-lower-out-pocket-expenses-insulin
https://www.cms.gov/files/document/insulin-common-questions.pdf
https://www.medicare.gov/find-a-plan/questions/home.aspx
Suppliers can use Medicare eligibility tools available in the myCGS and Noridian Medicare Portals, as well as many billing software applications, to determine which Medicare patients are changing to Medicare Advantage before the switch occurs! By entering a future date of service for the check, the eligibility search will return the insurance details effective next year.
By checking 2021 eligibility in December for Medicare patients, especially those with recurring rentals that may not have direct interaction with staff, suppliers can proactively secure the medical documentation necessary to continue the billing cycle. Waiting until the inevitable January denial is certain to depress cash flows and increase strain on the billing department.
Engage Patients Directly
Every patient interaction from now until January is an opportunity to identify insurance changes and preserve cash flows with less effort. With every patient call, customer service personnel should consistently perform a future eligibility check and ask about changes to insurance coverage.
Moreover, suppliers can include colored flyers with patient statements to notify customers of the need to alert the billing department of any upcoming insurance policy changes. Use the opportunity to remind customers that new insurance may require:
- Prior authorization.
- Retesting.
- Office visits.
- A supplier change (when the current DME provider is not in network with the new insurance company).
Suppliers should also evaluate new and existing plans in which they participate. Plan offerings change; those with previously closed networks may once again accept new providers. However, suppliers must have a clear understanding of the fit and fitness of a plan before agreeing to participate. Above all, efficient organizations must actively educate employees and customers on which local plans they accept. Planning and clarity allow suppliers to keep the patients they can and help the others with unsustainable coverage move on.
To start, suppliers can use the Medicare find-a-plan website to take stock of which Advantage plans operate within their service area. To use the tool:
- Navigate to the find-a-plan website.
- Click [Continue without logging in].
- What type of coverage are you looking for? Click [Medicare Advantage Plan].
- Enter your five-digit zip code.
- Click [Select Your Location].
- Do you get help with your costs from one of these programs? Click [I’m not sure].
- Click [Continue without logging in].
- Do you want to see drug costs? Click [No].
- Click [Next] to view plans.
This year, a new Part D and Medicare Advantage benefit is likely to increase the number of patients changing insurance. Hundreds of plans permit diabetic patients to pay a flat $35/month co-pay for insulin, regardless of unmet deductibles or phase of coverage. CMS advertises the benefit will save the average senior $446 annually.
Because the cash flow disruption could be worse than usual, suppliers have one more reason to proactively verify eligibility for Medicare customers before the end of the year. Carve out dedicated time now to communicate with patients, perform eligibility checks, and follow through with necessary insurance coordination between the patient, doctor, and insurance carrier. Doing so will prevent unnecessary denials and decreased profits.
SOURCE LINKS
https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Medicare-Open-Enrollment-Print-Ad.pdf
https://www.cms.gov/files/document/insulin-costs-beneficiaries-infographic.pdf
https://www.cms.gov/newsroom/press-releases/cms-launches-groundbreaking-model-lower-out-pocket-expenses-insulin
https://www.cms.gov/files/document/insulin-common-questions.pdf
https://www.medicare.gov/find-a-plan/questions/home.aspx
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