Inyeda W.’s Post

The Improving Seniors’ Timely Access to Care Act will: ·        Establish an electronic prior authorization process for MA plans including a standardization for transactions and clinical attachments.  ·        Increase transparency around MA prior authorization requirements and its use.  ·        Clarify CMS’s authority to establish timeframes for e-PA requests, including expedited determinations, real-time decisions for routinely approved items and services, and other PA requests.  ·        Expand beneficiary protections to improve enrollee experiences and outcomes.  ·        Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process. #priorauthorization #Itilitihealth

What are my Medicare rights? All people with Medicare have certain rights and protections. You have the right to: • Be treated with courtesy, dignity, and respect at all times. • Be protected from discrimination. • Have personal and health information kept private. • Get information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors. • Learn about your treatment choices in clear language you can understand, and participate in treatment decisions. • Get Medicare information and health care services in a language you understand. • Get your Medicare information in an accessible format, like braille or large print. See “CMS Accessible Communications” on page 107. Note: If you need plan information in a language other than English or in an accessible format, contact your plan. • Get answers to your Medicare questions. • Have access to doctors, specialists, and hospitals for medically necessary services. • Get Medicare-covered services in an emergency. From the "Medicare and You Handbook 2022" Need no cost help? Call Sheryl Gulan Lic #19582450

You’ve successfully enrolled in your Medicare benefits. Not sure what to do next? 🤔 Understanding how to use your Medicare is the next step for a smooth transition in to your new healthcare coverage. Let's read the article and we will walk with you step-by-step on your Medicare journey. 

If this seems like deja vu, it is. The Improving Seniors Timely Access to Care act stalled in the senate in 2022 and was given new bipartisan life this week. If passed, this bill aims to: ✅ Establish an electronic prior authorization process for Medicare Advatnage plans. ✅ Clarify HHS' authority to establish timeframes for electronic prior authorization requests. ✅ Expand beneficiary protections. ✅ Require HHS and other agencies to report to Congress on program integrity efforts. 📢 Sound familiar? 📢 Not to be confused with the CMS Interoperability and Prior Authorization Final Rule that passed in January of this year that will: ✅ Require MA plans to provide specific reasons why a prior authorization is denied and established turnaround time requirements. ✅ Expand electronic prior authorization options with interoperability. ✅ Finalize API requirements to create a more efficient prior authorization process. Healthcare doesn’t need more regulation that only applies to a handful of plans and payers. Common sense medical policies, reduced administrative burdens in care delivery and trust in trained healthcare professionals is the only overhaul needed. #healthcarefinance #revenuecyclemanagement

Dear network, I have a question about the "principles" behind Australian #Medicare policies, particularly the "safety nets" (https://lnkd.in/gSHykiGC). These are meant to help people with significant health expenses, by reimbursing 80% of their out-of-pocket costs(*) after they meet the threshold. Take a specialist consultation, for instance. In Sydney, a private specialist consultation typically costs AU$400 to $500, with a Medicare rebate of around $100. So, a "normal" patient would pay $300 to $400 out-of-pocket. But a patient who has already met the safety net threshold will be reimbursed 80% of this cost—on top of the "regular" Medicare rebate. Therefore, they will end up with only $60 to $80 real out-of-pocket costs. Nonetheless, this is only applicable to "out-of-hospital" costs. In-hospital costs are NOT eligible for the safety net. And this is my question. Why is that so? What is the #logic behind this rule? What is the justification for #denying a #benefit to someone because their treatment requires hospitalisation? ***** Here is a #real #lived #experience: Someone reached the safety net threshold sometime during the first half of 2022. Late in that same year, this person required a surgical procedure. When scheduling the procedure, in a private hospital, the surgeon's administrative staff explained that because they had reached the threshold, the surgeon's fee would be reimbursed at 80%. Reassured that they could afford this procedure, the person paid the surgeon fee (AU$1800) upfront - ten days prior to the surgery. After the surgery, the person submitted a claim to Medicare, attaching the receipt from the surgeon's practice, which includes explicitly the "Item number" and the "Site" name, which contains the word "Hospital". As advised by the surgeon's staff, Medicare actually reimbursed 80% of the $1800 - i.e. $1479.20 - a couple of weeks later. #Fast #Forward to May 2024 - 18 months later. The same person receives a very #distressing phone call from Medicare, notifying them that they will receive a debt recovery notice, and have 30 days to pay back $1300 ish for overpayment (**) because this was an in-hospital procedure and therefore not eligible for the safety net. Now I have a lot of other #questions - not related to the #principles I enquire about at the beginning of this post - but about the #practical side of this process: * Why would the surgeon's staff spread #misinformation? Isn't it their job to know what procedure is eligible for what benefit? Are they #liable for that? * Why would Medicare do this initial error? And why would they find the error after 18months? * Why would they go straight after the patient - with a quite short deadline to pay a significant debt? I imagine the same surgeon has been doing this same procedure hundreds of times, with consequently dozens of safety net patients triggering the same error. Shouldn't Medicare look into that first?

Understanding how to use your Medicare is the next step for a smooth transition into your new healthcare coverage. Let's read the article and we will walk with you step-by-step on your Medicare journey: https://lnkd.in/gA4afDMC

On a regular basis, we see #MedicareRevocations resulting from the mere inadvertent failure of a provider to update its enrollment profile. Read more in our recent article.

The landscape of Medicare enrollment actions is evolving, and staying compliant is more crucial than ever. In our latest article, Frier Levitt attorneys Nicole DeWitt and Theresa DiGuglielmo shed light on the stringent reporting and compliance policies necessary for healthcare providers to maintain their Medicare enrollment. Dive deeper into these critical updates by reading the full article here: https://lnkd.in/et7VrpRn If you need legal guidance or have concerns about your practice's compliance with Medicare requirements, contact Frier Levitt to speak with an attorney. #MedicareCompliance #HealthcareLaw #ProviderEnrollment #FrierLevitt

Medicare Monday! Qualifying and applying for Medicare doesn't have to be a complex journey. If you're 65 or older or meet specific criteria due to disability or certain medical conditions, you're likely eligible. Let's make this process smooth and personalized together! Contact me at 864-844-3464, and I'll guide you through every step, ensuring you have the coverage you need for a healthier future. Empower your healthcare choices with expert assistance! 🌈👩⚕️ #NavigationPlanningGroup #NPG #MedicareMonday #MedicareGuidance #HealthcareSimplified #ContactMeToday 📞

Medicare Open Enrollment (Oct 15 to Decr 7) and Medicare Advantage Open Enrollment Period (Jan 1 to Ma 31) "both offer different opportunities for adjusting coverage." https://ow.ly/6prY50TsqHU #medicare #medicareopenenrollment