"We Follow Medicare Guidelines" They Say…

Published in Complex Rehab on November 20, 2020

Many Medicare beneficiaries are being solicited by private insurance companies offering Medicare Advantage Plans via TV commercials. These Medicare Advantage Plans pose as Medicare and some of them even use celebrities to pitch their product. Read the fine print, as they are not affiliated with Medicare.

They are trying to convince Medicare beneficiaries to select their “Advantage Plan” over original Medicare Fee for Service (FFS) by stating they offer all the standard benefits of Medicare with a lower out-of-pocket cost.

But wait there’s more: These plans often state they provide additional benefits, such as gym memberships, transportation and eyeglasses. How can they provide more benefits with a lower cost? How can these private, for-profit insurance companies run all these TV commercials and pay celebrities and make a profit?

While some of these plans are good for the beneficiary’s needs and are fair to suppliers with reimbursement, many are not. Some are able to offer more for less due to an increased number of members, thus spreading the costs over a larger pool; however, many others are able to do this by not actually providing the same benefits as original Medicare.

Many of these plans don’t follow Medicare’s payment rules, and some attempt to pay for Complex Rehab Technology (CRT) wheelchairs on a rental basis, deny expensive electronics that are necessary to operate power positioning, and deny payment, thus plunging the CRT supplier into the labyrinth of appeals.

Read the full article from Mobility Management.


TAGS

  1. billing & reimbursement
  2. complex rehab
  3. vgm

From Our Experts

Maximize Your Heartland Experience: Tips, Tools, & Must-Knows thumbnail Maximize Your Heartland Experience: Tips, Tools, & Must-Knows Here's everything you need to know to ensure a smooth, successful, and unforgettable Heartland experience. Understanding the Value of ATP Certification and ATP Academy thumbnail Understanding the Value of ATP Certification and ATP Academy Becoming an ATP is a popular path often taken by occupational therapists (OTs), physical therapists (PTs), occupational therapy assistants (OTAs), physical therapy assistants (PTAs), and wheelchair technicians. With an ATP certification, one can both fill the needs of suppliers to sell certain wheelchairs and demonstrate that they have the skills and knowledge to complete their job as defined by the leading authority in the credentialing industry. Mobility Awareness Month: Celebrating the Impact of Mobility Providers thumbnail Mobility Awareness Month: Celebrating the Impact of Mobility Providers May is Mobility Awareness Month, a time recognizing the importance of mobility solutions, the professionals who provide them, and those who rely on them. U.S. Rehab's Live Tech Training and ATP Gateway Training Programs for 2025 thumbnail U.S. Rehab's Live Tech Training and ATP Gateway Training Programs for 2025 Our focus and one of our key drivers to help support our U.S. Rehab members is to continue to lead the way in complex rehab technology (CRT) training, offering Live Tech Training sessions and a new ATP Gateway Training Program in 2025. Marketing: Avoid Overspending thumbnail Marketing: Avoid Overspending Marketing your business effectively doesn't have to be costly. Adventure and Connections Await at Heartland 2025 thumbnail Adventure and Connections Await at Heartland 2025 This year's Heartland Conference promises an exciting lineup of activities designed to foster connections, inspire innovation, and create lasting memories. Accessories Just Got Easier to Bill thumbnail Accessories Just Got Easier to Bill CMS's decision to revise and expand E1028 and create three new HCPCS codes based on where it's being used on a wheelchair is a "win” for the industry. Heartland Conference Announces Extended Early Bird Special and New Refund Policy thumbnail Heartland Conference Announces Extended Early Bird Special and New Refund Policy Register for Heartland before April 30 to save $100. If circumstances prevent you from attending, we will fully refund your registration through June 1.