Medicare Advantage Plan Billing Tips

Today, nearly a third of Medicare enrollees are covered by a Medicare Advantage plan—up from roughly a quarter in 2010. Depending on your state or even your city, the number of Medicare patients enrolled in an Advantage plan can vary, from about 55% in Minnesota down to 1% in Alaska. But many providers often don’t understand how these plans work in relation to conventional Medicare.

One key term to remember is the alternate name used for these plans—Medicare replacement. Just as the word replacement implies, these plans take the place of regular Medicare Part B coverage. If a patient has a Medicare Advantage plan, the claim should not be billed to Medicare. These are not to be confused with supplemental plans that are billed after Medicare pays.

Verify Insurance. Check Eligibility.

It’s important to verify every patient’s insurance information prior to their visit to avoid costly delays in getting paid. Some patients might not even realize they enrolled in an Advantage plan and simply present their Medicare card. 

By checking eligibility in advance, your office can ensure claims are filed to the correct payer right after the patient’s visit. You might even find the patient has additional coverage they weren’t even aware they had—Medicare keeps a record of reported crossover plans, including supplemental coverage, so a quick eligibility check can save time down the line.

Don't Get Lost in Payer Portals

When it comes to checking eligibility and benefits verification though, it’s easy to get lost in the different payer portals or IVR systems. Verifying a patient’s insurance eligibility and benefits is a critical first step. A RCM service like Fast Pay Health can help by handling the verification process for you, saving you staff time and money so you can continue to focus on your patients’ care. We ensure that demographic and insurance data are correct by verifying plan coverage and the amount a patient may owe (e.g., co-pays, co-insurance and deductibles).

About Fast Pay Health RCM: At Fast Pay Health, our revenue cycle management specialist are experts at making sure claims are clean and free from errors, before we submit them. We take care of the billing hassle to maintain consistent cash flow and improve the turn-around time on your claims. We work with each of our offices to provide a solid RCM solution. No two practices are alike and we pride ourselves on maintaining open communication between every office and their Fast Pay Health account manager to stay in sync. Contact us for a free practice analysis to see how we can help you.