by Mario Fucinari •
DC, CCSP, CPCO •
Have you noticed an increase in the number of Medicare Advantage calling your office? A recent study revealed that in 2023, the average Medicare beneficiary could choose from 43 different Medicare Advantage plans in their area. However, most Medicare Advantage plans vary on their coverage, co-pays, and if you have to be in their PPO plan for the patient to have coverage for traditionally covered services such as spinal manipulation. You MUST treat every Medicare Advantage plan as a private contract and check on patient benefits before accepting them for care.
Questions to Ask:
- Do you follow the Medicare Fee Schedule?
- Do you cover services other than Spinal Manipulation?
- Do you honor/Accept the AT modifier?
- Do you accept the ABN form? (most DO NOT, so use the GFE)
On April 5, 2023, HHS and CMS announced that they are finalizing a rule to put strong protections in place so that Medicare Advantage (MA) plans will stop misleading patients and providers. The final rule will strengthen Medicare Advantage and hold health insurance companies to higher standards by cracking down on misleading marketing schemes by Medicare Advantage plans.
The final rule includes changes to protect people from confusing and potentially misleading marketing practices. Ads will be prohibited if they do not mention a specific plan name or use the Medicare name, CMS logo, and products or information issued by the Federal Government, including the Medicare card, misleadingly. Further, the final rule strengthens accountability for plans to monitor agent and broker activity.
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Why is the Discount Challenge prize amount $15,024? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $15,024 per patient, that’s not per provider, that’s PER VISIT. Stinks, doesn’t it? To us, the prize amount is worth the investment if we can help our profession better understand proper discounting.