Re: Patient comes in with Medicare and Medicare Advanatge Cards

[Steve Verno]

THis is why we cross our eyes and dot our tees.

[Steve Verno]

i tried to say you cant but missed the t key.

[Steve Verno]

I agree

you can(T) file with Medicare and Medicare Advantage at the same time. Even if Medicare does pay, in 4-5 years they will demand the payment back.   This doesnt count if the advantage plan plays games and wants their payment back.   

With commercial insurance, I have seen patients where both policies are primary. Twice in 30 years.   Both pay as primary.  We have to refund the patient the overpayment. 

I know what this is....  You were testing us!!  Right!!!

[Pay_My_Claims]

Charlene,

You are awesome--and Steve, yes, I know that--LOL  I should have made myself more clear in the post--it was meant as a question for either the newbies, OR to see how current billers train the front desk staff to handle the situation

My whole point of the post was that there are occasions when elderly people are VERY confused and think that Medicare is their primary and Medicare Advantage is their sceondary.  When the front desk clerk tries to explain it, sometimes they get very upset and may even begin to cry.  I always explain to front desk staff to not argue with them and upset them more.  Simply take both cards from them--and WE, as billers know who to bill, and we, as billers should explain Medicare, Medigap and Medicare Advantage to the front deks staff if they are unclear.

Thank U

[Pay_My_Claims]

So Michelle what do you tell the front staff to do?

Once you have verified the two plans, you do know there's nothing wrong with submitting to both and there is nothing wrong with the patient getting reimbursed twice.  (long as insured is making premiums)
Being overinsured isn't against any rule. 

WHAT??? You can't file both. If you have ever verified Medicare, you will notice that the Medicare HMO, PFFS will be listed on the CWF showing that the benefits are manage by them. and you will get a denial of co109 showing that the claim should be paid by another provider. The initial benefit of the Medicare Advantage plans were for the pharmacy benefits. Some clients only enroll in the part D benefits only and verifying Medicare will show that its RX only. If you have Medicare/Medicaid the Advantage program isn't an advantage to u. Medicare still reimburses the Advantage plans, so why would medicare pay the bill again???

[Pay_My_Claims]

Much simpler just to say "Over insured"
And yes there is such a thing. That's because these scam plan's invite the retired people out to lunch or breakfast at Denny's and sell them insurance they don't need.   
Happens A LOT..not uncommon at all.

Well Medicare has gotten stricter with regards to the Advantage plans. They would go in and out of them like fresh panties and it was difficult to keep up with what they had. Luckily the former hospital I worked for required verifications on each hospital stay so it was easier to catch, but there were times when I saw clients enrolled in more than one plan!!! I worked for a program where physicians went out in the community to see clients at home. We went to the senior housing facilities and thats where we found the hardest hit for the advantage plans. The seniors would be so lonely they were happy someone was in the home and just signed up for each salesperson. Now when you enroll you have to keep it for a year before you can sign out.

[Steve Verno]

Breakfast at Denny's?  Sign me up for the country slam. 

At our local wal-mart they're all lined up in a neat row in the pharmacy department. I stood off the side and listened to the dribble being presented. I asked one question:  What do these people do with their Medigap plan when signing up for your Medicare Advantage HMO plan?   Medigap???  Whats that?   Then I hear, you'll never have any out of pocket expenses.  YOu'll never have to file a claim.  Here's a list of our preferred providers who work with us.  I looked and found several of my doctors.  i said, these doctors are not part of your network. They terminated with you 7 years ago.  You sure?  Yup, I wrote the termination letters myself and I still have a copy on DVD.  Why are you so concerned about all this???  I get my Medicare card in 2 years.  I also have to deal with these people you talk to.   

It gets even worse the more north you go.  Just a short 30 miles north is an entire town of seniors.  Not a mobile home park, a full fledge city of grey hairs, golf carts, Cadillacs, tons of clinics in strip malls, and Medicare Part B/C.   They even open their own strip mall store.   Lookie here, I have both my Medicare and Advantage cards. I get all the free care I want.  Nice!  All the free medical care and a free country slam breakfast on top.  Life is good.

[Pay_My_Claims]

A new patient comes in with an Original Medicare card and a Medicare Advantage card-----------the patient INSISTS he/she has BOTH insurances!

What do you tell your front desk staff to do in handling this scenario???

She is lucky...Most just bring in the Medicare card and insist that is what they have. Most don't completely understand the Medicare advantage plans. Never Argue, I have told clients, yes you still have Medicare benefits, however your medicare advantage plan that you signed up for manages those benefits. If you have questions, you can contact 1-800-MEDICARE

[Steve Verno]

A patient can join a Medicare Advantage program (Medicare Part C) and still have their original Medicare Card.  Once they join Part C, it replaces original Medicare, so they dont have both at the same time.

MY mother joined Avmed, a Medicare HMO (Part C).   She stll has her regular Medicare card still, but she knows her coverage is with Avmed.

Me?  Id make a copy of both.  Have the patient fill out an insurance affidavit form, verify benefits with the Advantage carrier and send them the claim.  Id also very privately have a chat with the patient about Medicare Part C.

House, the TV show has excellent statements I believe in:

1)  Medical Billing is Complicated
2)  All patients lie.