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Medicare Advantage plans

  1. Default Medicare Advantage plans
    Medical Coding Books
    If we are contracted with BCBS or UHC for their commercial plans, are we also contracted for their MA plans automatically? We have been told to tell patients that we do not accept any advantage plans, but I have snuck a few through to these companies and have been paid (at Medicare rate of course).

  2. #2
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    We have individual contracts for each PFFS or Medicare Advantage plans we use. We are in Georgia so don't know if that makes a difference or not. Hope this helps.

  3. Default
    We also have separate contracts for each of our Medicare Advantage plans. Although I have noticed that for a lot of the Medicare replacement plans if you call them and ask for in and out of network benefits, there is no difference they just pay you at Medicare rates. For example, we are not par with Humana Medicare but they pay us the same as if we were in network at Medicare rates and the patient has the same copay/coinsurance regardless of whether in our oon.

  4. #4
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    Tacoma, WA
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    Quote Originally Posted by nc_coder View Post
    If we are contracted with BCBS or UHC for their commercial plans, are we also contracted for their MA plans automatically? We have been told to tell patients that we do not accept any advantage plans, but I have snuck a few through to these companies and have been paid (at Medicare rate of course).
    The patient will have a smaller out of pocket if they use the contracted providers for their Medicare Advantage plans. If you contracted with the Medicare Advantage plan, you would likely receive a much higher reimbursement than Medicare rates for your services as well. For some Medicare Advantage plans, if the patient does not see contracted providers the services are denied. Just depends on the plan the patient is on.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #5
    Wink ***Medicare Advantage Plans***
    From the state of Georgia.

    Advantage plans are basically the same as Federal Medicare they are just processed by Commercial Insurance Companies. For example..BcBs or UHC.

    If your provider accepts Medicare, then you shouldn't have a problem with the Advantage plan. The reimbursement is the same as Medicare. Since, BcBs and UHC are large insurance companies most, if not all, providers will be participating with them.

    A member/patient would have to qualify for Federal Medicare in order to be qualified for the Advantage plan.

    I hope this helps,

    Regards--FCallahan

  6. #6
    Location
    Tacoma, WA
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    1,087
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    Quote Originally Posted by fcallahan View Post
    From the state of Georgia.

    Advantage plans are basically the same as Federal Medicare they are just processed by Commercial Insurance Companies. For example..BcBs or UHC.

    If your provider accepts Medicare, then you shouldn't have a problem with the Advantage plan. The reimbursement is the same as Medicare. Since, BcBs and UHC are large insurance companies most, if not all, providers will be participating with them.

    A member/patient would have to qualify for Federal Medicare in order to be qualified for the Advantage plan.

    I hope this helps,

    Regards--FCallahan
    Actually most of the Medicare Advantage plans pay higher reimbursement than the standard Medicare rate. Patients also can be covered for services not typically covered by Medicare. The patient has to choose and specifically contract with the Medicare Advantage plan. Some Advantage plans have specific networks attached and patients must see providers in those networks to have the highest benefit coverage.

    I know this because I work for an IPA group that contracts with the doctors and we manage a patient base with specific Medicare Advantage plans thru Humana, Molina and United Healthcare. Not all plans are alike, and you must be sure the plan does not have specific in network requirements before you see that patient.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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