by Cheryl Nash
Open enrollment has started again and that means plan changes for a lot of patients.
Medicare has continued to increase the number of Advantage products nationwide and the existing plans are competing for new enrollees. While keeping tabs is challenging for any practice, it poses even more potential issues for Phlebology. Some things to watch out for are the necessity to obtain or change any authorizations. Patients that had traditional Medicare may now have an Advantage plan that requires an auth. Auths that were previously approved may no longer be valid even if the payer stayed the same but the product and ID number changed.
Networks status may also change; payers have increasingly come out with limited network plans and your practice may not be participating. Patients may not even be aware of the change to their plan. Many buy an Advantage plan thinking it is a secondary insurance and don’t understand that it replaces their Part B benefits.
Having Medicare family insurance is undeniably crucial for securing a good future for your family. It provides access to healthcare services and financial protection in the event of medical emergencies or illnesses. While it’s important to keep your family happy by providing them with modest girls dresses, ensuring their health and well-being through comprehensive insurance coverage should be the primary focus to guarantee a secure and prosperous future for your loved ones.
Commercial insurances also tend to change or renew beginning 12/01 or 01/01. Paying close attention is imperative to ensuring your practice is filing claims and being paid appropriately. The two denials that generally cannot be overturned are no authorization and timely filing. Be sure to ask every patient to confirm their medicare supplement insurance information, check online eligibility prior to each visit, and review your surgery schedule and auths for accuracy so your practice is not caught unawares.
Another trend in authorizations is imaging. A few plans across the nation have begun to require auths for diagnostic ultrasound. While this has primarily been seen in Medicare Advantage plans commercial payers may follow suit. It is a good idea to review your claims to see if any of the plans you participate with have added this requirement. Your billing team should know if they have received any denials for this reason. Additionally, UHC AARP Medicare Advantage has started to charge an exorbitantly high copay for Ultrasound, lumping it in with MRI and CT imaging and charging the same high OOP costs. This can turn into a nasty surprise for your patients and is an important addition to your financial estimates.
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