"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

U.S. Rehab Tech Training Coming to Philadelphia and Birmingham, AL thumbnail U.S. Rehab Tech Training Coming to Philadelphia and Birmingham, AL U.S. Rehab is excited to host Tech Training in Philadelphia July 26-27, 2022, and Birmingham, AL September 13-14, 2022. VGM or U.S. Rehab members can register now online. VGM's 21st Heartland Conference Builds HME Community thumbnail VGM's 21st Heartland Conference Builds HME Community More than 1,000 people from across the U.S. and Canada converged June 13-15 in VGM's hometown of Waterloo, Iowa, for three unforgettable days at the 21st annual Heartland Conference. Complex Rehab Technology and Outcomes-Based Healthcare thumbnail Complex Rehab Technology and Outcomes-Based Healthcare The Complex Rehab Technology (CRT) industry, along with many others in the DME space, is moving to an outcomes-based or performance-based system versus the fee-for-service system we have been in for decades. DMERT Group Names Wayne Grau as Chair of Executive Board thumbnail DMERT Group Names Wayne Grau as Chair of Executive Board The DMERT Group has announced Wayne Grau as the new Chair of their Executive Board. Greg Packer, president of U.S. Rehab and previous Chair of the DMERT Group, announced his resignation to be effective upon the naming of a successor. Cybersecurity in 2022: What to Watch For thumbnail Cybersecurity in 2022: What to Watch For The landscape of cybersecurity is always evolving as new technologies come along and attackers become savvier. Jay Bracken takes a look at some of the biggest cybersecurity trends in 2022. Online Registration Closes June 6 for Heartland 2022 thumbnail Online Registration Closes June 6 for Heartland 2022 Online registration for VGM's 21st anniversary Heartland Conference will close June 6. Guests will still be able to register on-site for the in-person educational event June 13-15 in Waterloo, Iowa. Why the Right to Repair is NOT the Right Thing to Do to Address Delays in Wheelchair Repairs thumbnail Why the Right to Repair is NOT the Right Thing to Do to Address Delays in Wheelchair Repairs Right to Repair legislation has popped up in several states and is a topic that impacts all U.S. Rehab members. If passed, it could have devastating consequences to patients attempting to repair their own medical equipment. OIG Report – Medicare “Advantage” Organizations Restrict Beneficiary Access to Medically Necessary Services thumbnail OIG Report – Medicare “Advantage” Organizations Restrict Beneficiary Access to Medically Necessary Services Dan Fedor outlines recent report from the Office of the Inspector General (OIG) and how it confirms that many Medicare Advantage (or replacement) plans can lead to denials, underpayments, and delays in payment.