Bill These Patients with an Abundance of Caution
The FCA has been receiving an increase in calls from members reporting notices from Medicare and Medicare Advantage insurers that they must refund patients for copayments and deductibles. These determinations are a result of the Qualified Medicare Beneficiaries (QMB) program which was reported about over a year ago.
In summary – The following actions should be considered:
• Consider asking every patient on every visit if there have been any changes in their health care insurance. Although regular Medicare only changes once a year on January 1st, Medicaid and replacement plans can change much more frequently. Some offices have incorporated a yes/no response to this question on their sign-in sheet or equivalent.
• If the patient is a QMB, these rules apply whether or not you are enrolled in Medicaid.
• Potentially covered services by either Medicare and Medicaid include spinal manipulations visits, and some x-rays.
• Medicaid’s reimbursement for a spinal manipulation visit includes an exam if necessary, but does not cover an exam if a spinal manipulation is not rendered.
• Consider the QMB possibilities when implementing your “No Surprises Act” Toolkit. The FCA’s information on this can be found on fcachiro.org. After logging on, search for “No Surprises Act” or click here to be redirected to that page.
• Monitor your EOBs in a timely fashion to identify potential issues quickly, before either refunds or patient balances become excessive or delinquent.
• Review network contracts to understand what services are bundled in YOUR contract.