October 24, 2011
Understanding Medicare "Replacement" Plans
Dear Doctors and Staff,
Nothing is "simple" including Medicare replacement plans. The Medicare Carriers are losing "customers" to these plans and are not happy with them.
Just so you know....there are two kinds of replacement plans:
- Plans that subcontract...in other words, the patient of this plan is still on a contract with Medicare and is still with Medicare. Which means....when we see this patient in our Chiropractic office, we must follow ALL the Medicare guidelines, even when billing the replacement plan. Even if the replacement plan has a $35.00 co-pay, we must still bill.
- If your patient has a "Medicare replacement" and the patient has bailed out of Medicare and not paying Medicare premiums each month, this person is now in the same category as the rest of your patients. You do not have to bill the replacement insurance and your fees are the same as your non-Medicare patients....Unless....you bill this replacement insurance one time. Now you are on contract with the Medicare replacement insurance company to follow ALL the Medicare guidelines, fees and billing. Even though the replacement company has a $35.00 co-pay, and pays nothing on the claims, you must file for your patient.
IMPORTANT: If your patient tells you they have a Medicare replacement program, you must call your "Medicare Carrier", not the replacement insurance, and ask if your patient is in the federal "Medicare" program or not. The answer is either yes or no. You will then know who, what and where to bill.