Getting Ready for the New Year
Published November 3, 2011 | 
As Patient Access Reps we are required to keep up-to-date on all the changes and updates happening with various insurance plans that we deal with everyday. That includes doctor’s office personnel and hospital accounts receivable or financial accounting members. The easiest way is to have each of the major insurance websites bookmarked so that you can find the information for the coming year at your fingertips. Medicare has posted the changes for 2012 here: http://www.medicare.gov/cost/
Traditional Medicare Patient Costs beginning January 2012:
Part B Deductible (Doctor’s Office and Outpatient Hospital services)
Pay $140 per year and then 20% for most services
Hospital Inpatient Stay You pay:
$1,156 deductible per benefit period
$0 for the first 60 days of each benefit period
$289 per day for days 61-90 of each benefit period
$578 per “lifetime reserve day” after day 90 of each benefit period
(up to a maximum of 60 days over your lifetime)
Medicare Advantage Plans Example of Patient Costs:
Tricare Patient Costs Beginning October 1, 2011 to September 30, 2012:
(Go to the Tricare Website to Get the Complete Information)
These are just two of the most seen insurances in our area but they are good examples of what you will encounter with the rest of them. You will need to make a listing of your most popular insurances that your company encounters with their copays as the patients come after the first of the year. Good Luck and Happy Holidays in the coming months.
Insurance Alternatives for Our Patients
Published September 12, 2011 | Here in Florida for a couple of years we had the “Cover Florida” program that was supposed to allow anyone without insurance some kind of coverage guaranteed. However, due to more sick than healthy patients signing up for the coverage all of the Insurance Companies pulled out of the program for being too expensive to run per an article posted in the South Florida Business Journal March 25, 2011.
Now, the Federal Government and most of the states have begun insurance programs for those who have pre-existing conditions and haven’t had insurance coverage for 6 months or more. It is called the Preexisting Health Insurance Program or PCIP for short. They have a website with lots of information, an online application, informational brochure, plan costs, etc. Half of the states are sponsored and run by the Human Resources Department of the Federal Government. The other states have already had their own plan in place. There is a coverage map to see if your state is covered by the Federal Government or your State Government Agency.
Visit Insurance Websites
Published February 16, 2010 | Almost every major insurance type has a main site that is just filled with free information for the Patient Access Representatives as well as their customers. Most companies are required to tell you about their requirements for billing, precertification, etc. Visiting their websites and going to the provider section should net you a billing manual and contact information to followup with claims, notify them for precertification and where the claims should be going. Getting the right information the first time is what we should strive to do. This will decrease our Accounts Receivable Days and bring the money in quicker. This will make the management people happy and may translate into more money for your pocket in the form of raises. I don’t know about you but getting paid is why I go to work.
Medicare has a great site with loads of information. There are several states that have more Medicare patients than others and if you are in one of them then going to the www.medicare.gov website is essential. Of course, those will Railroad Medicare have their own site at: http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Railroad%20Medicare~Resources
If you have a large military base in your area then you really should go to the Tricare Site for Your Area. There are three of them depending on your state. Tricare West is http://www.triwest.com/provider/. Tricare South is http://www.humana-military.com/south/provider/provider.asp. And finally Tricare North is http://www.tricare.mil/tma/providerinformation.aspx
Every state has their own Medicaid site. To Find yours you can go to your favorite search engine and type in your states name and then Medicaid or you can go to the Federal Medicaid site and you will get the Federal Guidelines that all states must follow and find the links for each of the states as well. The Federal site is at: http://www.cms.hhs.gov/home/medicaid.asp. To find all the state sites in one place go to this website: http://64.82.65.67/medicaid/states.html.
These should get you started and next month we will get you more information about other insurances!
Do You Know the Dual Eligibility Rules?
Published December 15, 2009 | Medicare/Medicaid patients are not to have their cost-shares, co-insurances amount collected from them. That includes those patients who have only Medicare Part A and Medicaid or only Medicare Part B and Medicaid OR Medicare HMO/PPO/PFFS and some kind of Medicaid as well. If there is a Cost-share or copayment due by the patient the provider is to either accept the Medicare Insurance as payment in full or try billing the State Medicaid for the payment..
Additionally, we are not able to write the fee off as bad-debt as CMS (Centers for Medicare & Medicaid Services) does not reimburse providers for bad debt for uncollectible co-payments, coinsurance and deductibles of Medicare or Medicare Advantage Plan members. Looking at the CMS website for confirmation at: www.cms.hhs.gov/
In the Dual Eligible section I found some interesting information about that and pointers to other useful information as well. The websites lists the Dual Eligible Categories From Medicaid Only, Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI) and finally Qualified Disabled and Working Individual (QDWI). There are only 2005 and 2006 Dual Eligible Income Limits on site and they have a link for the 2009 Poverty Guidelines put out by the Government every year: http://aspe.os.dhhs.gov/
poverty/09poverty.shtml