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Medicare Open Enrollment – Traditional Medicare & Medicare Advantage Options

October 6, 2013 0 Comments

iStock_000021577716SmallMedicare open enrollment season is upon us.  No doubt when you are watching late night TV you are seeing all the ads from the likes of Humana and others targeting Medicare beneficiaries with the benefits of switching to a Medicare Advantage Plan (Medicare Part C).  Open enrollment starts October 15 and continues through December 7, 2013.  At this time beneficiaries that are on traditional Medicare can switch to a Medicare Advantage Plan, or alternatively those in a Medicare Advantage Plan can switch back to traditional Medicare.  Over the past few weeks Medicare beneficiaries have received via mail the “Medicare and You” booklet for 2014.  CMS sends out one per family, and alternatively if you are inclided to save the planet (and save the government some postage), you can opt to receive your copy on the web, or download to your iPad, Kindle or other eReader device.

So why does a provider need to be aware of this information?  Well first of all your patients may request your help in understanding how their therapy benefits might change if they leave traditional Medicare and switch to a Medicare Advantage Plan.  But probably most important as we reach the end of the year and patients are planning to switch plans, it will impact the provision of therapy services.  For example a patient that discontinues a Medicare Advantage Plan and opts to come back to traditional Medicare will now need all documentation compliant with Medicare requirements:  certification of a plan of care to begin, and the functional limitation reporting including selection of G code and impairment modifier based upon testing and therapist judgment.

What is so hard you ask?  Many beneficiaries may not report to you their change in Medicare coverage – and may not understand the need for providers to know.  So as we are moving through this fall open enrollment system keep your beneficiaries informed that any changes made to their Medicare benefits coverage may affect their therapy benefit, and that in order to provide the best therapy services that you can, you must provide services, document services and bill for services based upon their Medicare coverage as either traditional Medicare or the benefit design (and authorization process) for Medicare Advantage Plans.


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Nancy Beckley

Nancy J. Beckley MS, MBA, CHC: President-Nancy Beckley & Associates LLC. Compliance outsourcing, risk assessment, compliance plans, compliance training, auditing, due diligence, investigation support for therapy providers.

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