medicare advantage

  1. E

    Wiki Help with New PA-C

    My office hired in a new grad PA-C (eff. 9/2023). Her first day with us was October 30, 2023 and we've ran into a few bumps in the road. Our biggest concern is: She is not yet credentialed with Medicare. I am not quite sure if since she is not yet credentialed with Medicare, if she's able to...
  2. Q

    Question Medicare vs. Medicare Advantage

    Whose coverage guidelines would take precedence between Medicare (MCR) NCD and a Medicare Advantage (MA) clinical policy, where the MA's policy was more restrictive? For example: If MCR guideline allowed for treating a certain condition, but the MA plan's guidelines require additional criteria...
  3. E

    Question 99358

    We are billing 99358 to BCBS and Aetna medicare advantage plans and medicaid. They are denying this code. Is anyone else having this issue? Is there something we can be doing to get this paid? We are billing for nursing facilities. The providers review patient records before being seen in facility.
  4. K

    new medicare advantage rules 11/1/2018

    I'm curious as to what other's reactions are to the new MA RADV auditing rule proposed on November 1, 2018. What do you believe it means to compliance professionals and how does this fit into the existing structure for the MA program as you already understand it. What do you think it means and...
  5. J

    FQHC Billing Lab Services to Medicare Advantage plans

    Hi, I work for an FQHC in Hawaii and we are having issues with billing PPD tests and other lab services to Medicare Advantage plans like UHC, WellCare, etc. Is there anyone else billing/coding for FQHCs who can share how they are billing labs to Medicare plans? According to the Medicare FQHC...
  6. C

    Medicare advantage plan deny for no referral

    Our patient has a Medicare Advantage plan and she did not notify us of the change in insurance. Our claims are now being denied as not having a referral and they denied them to the provider to write off. We are not contracted with this MAO. Does anyone have any documentation they could point...
  7. A

    Contracted Rates with HMOs for Medicare Patients

    Can anyone tell me if a participating Medicare provider is prohibited by CMS to be contracted with an HMO at greater than 100% of Medicare's allowed amount? (specifically for Medicare patients that have an HMO) I know this pertains more to the billing side of things but I am not finding an...
  8. L

    Denials on 90471 from Medicare Advantage plans

    Good afternoon everyone, Has anyone, working as a FQHC, received any denials from Medicare Advantage plans for immune administration code 90471?? We have 28 denials where they state the procedure code is invalid. There are 2 different scenarios where we got denied. 1. Patient came in to...