Image
KMC 40 Marketing3

Join us in celebrating Kathy (KMC) Weidner's 40 years in Chiropractic!

Use coupon code Kathys40 at checkout and get your first month of Library Membership for $40 off!

Offer available to new members only. Expires February 28, 2023.

Learn More
Chronicles Banner 1

Don't miss the January 2023 edition!

We know you count on us to keep you up to date with the most important information in the profession. We have compiled updates, blogs, and news for you into this convenient digital publication.

Download Now
FWA announcement

New Course! | Fraud, Waste, and Abuse

Each year, billions of dollars are spent improperly because of Fraud, Waste, and Abuse. It affects everyone—including Chiropractic providers and teams.

Learn More!
OIG

There's no need to fear the OIG. We've got your back!

The most effective chiropractic OIG compliance programs are scaled according to the size of the practice!

Learn More
Telemedicine

Need more guided help? Work with a KMC coach 1-on-1

Sometimes you need more than a self-service, on-demand program and need an expert to analyze your issues, train the corrections, and help you implement the changes, so they stick

Learn More

Replacement Plans in Medicare

Replacement Plans in Medicare

Not all Medicare coverage is the same. In fact, as healthcare expenses increase and coverage decreases many qualified Medicare beneficiaries are making the choice to put aside their traditional Medicare and enroll in a Medicare Part C plan also known as a Medicare Advantage Plan (i.e., replacement plan).

 

Replacement Plans in Medicare

What is a Medicare Advantage Plan?

According to www.Medicare.gov, a Medicare Advantage Plan (like an HMO or PPO) is a Medicare health plan that qualified beneficiaries may choose as part of their Medicare package. These plans are very similar to traditional Health Management Organizations (HMOs), Preferred Provider Organizations (PPOs) and Private Fees for Service (PFFS) plans. These plans have their own rules for both treating and billing patients.

Medicare Advantage Plans (i.e., “Part C” or “MA Plans”) are offered by private companies approved by Medicare. If your patient joins a Medicare Advantage Plan, the plan automatically includes Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. This means that your patient does not have traditional Part B Medicare! In addition, Medicare Advantage Plans may offer other coverage such as: vision, hearing, dental, and/or health and wellness programs. Most also include Medicare Part D (Prescription Drug Coverage).

Medicare pays a fixed monthly amount to the companies offering Medicare Advantage Plans. These companies must follow the rules set by Medicare. However, each Medicare Advantage Plan may have different out-of-pocket costs and different rules for how patients obtain services (e.g., Is a referral required for specialists like chiropractors? Are they limited to doctors, facilities, or suppliers that belong to the plan?) Note: These rules may change yearly.

Don’t Be Fooled!

Unfortunately, most patients do not understand that Medicare Advantage plans replace their traditional (original) Medicare. There is no need for patients to provide the clinic a copy of their traditional Medicare card. They should provide a copy of their Medicare Advantage insurance card. We encourage you to train your staff on how to identify these cards properly during the intake process.

You will immediately see that the cards are not red, white and blue like traditional Medicare cards. The key is to look for the words Medicare Advantage on the front of the card. Most major payers will offer a Medicare Advantage plan option each year. In some cases, your office may be annexed into the plan as a preferred provider if your office participates in the payor’s commercial plans. Below you can see a Sample BC BS Medicare Advantage Plan Card:

 

Medicare Part C or Advantage Plans

Once you’ve identified the card you will need to know what is required prior to billing a Medicare Advantage Plan. What you need to know can be found at “The Ins and Outs of Billing Medicare Advantage Plans”.

 

The Ins and Outs of Billing Medicare Advantage Plans

 

What is a Deemed Provider in a Medicare Replacement Plan?

 

Your Compliance Plan and FDR
Image Image

After watching the webinar “Security Risk Management, A HIPAA Requirement”, I went to the government website and spent 4 hours trying to research what I needed to do and had to walk away as I was overwhelmed.  After contacting my Account Manager, and setting a time to review the Compliance materials that are available at KMC University, I now feel this is what I was looking for…simple steps to walk from A-Z.

Amy D.