Tuesday, June 18, 2024

When Does Permission To Contact Expire Medicare

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Which Services Qualify For A Cost

Medicare Advantage Plans

For the duration of the PHE, Medicare is waiving and will cover cost-sharing for COVID-19 diagnostic tests and visits related to COVID-19 testing. Additionally, physicians may voluntarily waive cost-sharing for non-COVID-19-related telehealth and virtual/digital services. However, Medicare will not pay any cost-sharing waived at a physicians discretion. Read the coding and reporting guidelines from CMS here.

Cost-sharing policies for private payers vary by payer. For more specific guidance, see this release from CMS. Review the Private Payer FAQ or contact your provider relations representative for additional information.

Note: Self-funded plans may opt out of some cost-sharing waivers. Similarly, Medicaid policies are established at the state level and may differ from national policies.

How To Compliantly Receive Permission To Contact

According to MCMG Guidelines, agents must have permission before they can make marketing calls. Cold calling, canvassing door to door, and other activities are strictly forbidden.

How does an agent get that permission? Well, one way is for potential clients to fill out a Business Reply Card . Another way is for the beneficiary to email a Plan or Part D Sponsor and request a return call. Beneficiaries can also ask a customer service representative to have an agent contact them. It is vital that the beneficiary initiate the contact.

On the BRC, phone call, or email, the consumer will indicate what program they want information about. A client should indicate whether they want information on Medicare Supplements, Medicare Advantage, or both.

Once a beneficiary gives permission for an agent to contact them, the agent still has to be careful. The permission only covers a very small window of service. Specifically, beneficiaries can only be contacted by the entity theyve requested contact from, and the agent can only discuss the products indicated on their BRC.

Medicare Scope Of Appointment Form

The Scope of Appointment is a requirement for in-person appointments. Agents must document their meetings with potential and current beneficiaries. The form goes on file for ten years and protects all parties. Sadly, many people have used a sales approach to profit from misunderstandings of the insurance world.

This form helps to protect people from falling victim to scams. Also, it allows the agent to prepare material for the meeting that can help you understand your best options.

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Establishing Permission To Contact Makes You A Better Agent

Establishing permission to contact is an agents best practice because it sets them apart from the unethical shady agents that do not comply and send intimidating emails or make unsolicited calls. Permission to contact also sets you up for the next step, scope of appointment forms.

For a more comprehensive overview of Medicare marketing, check out our Medicare Marketing Dos and Donts blog post!

Can I Provide Chronic Care Management Or Transitional Care Management Using Telehealth

Training Archives

Yes. CCM is already considered a non-face-to-face service. Patient consent is required. Verbal consent is sufficient and must be documented in the patient medical record. Patients who have not been seen in the office in the past 12 months must have an initiating visit, such as an office visit. The initiating visit may be provided via telehealth.

TCM is on Medicares list of covered telehealth services. Per Current Procedural Terminology , CPT codes 99495 and 99496 include one face-to-face visit that is not separately reportable. CMS has not specifically addressed this question but is otherwise covering such visits as stand-alone services.

To date, CMS is not considering a phone visit equivalent to a telehealth visit involving audio and visual technology. Given that CPT describes the visit included in TCM as face-to-face, we do not advise conducting that visit as a telephone visit.

The requirements for CCM and TCM can be found on the AAFP website.

Telephone E/M and e-visits should not be billed during the same month as CCM or during the same service period as TCM.

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What Is Considered A Covid

The Coronavirus Aid, Relief, and Economic Security Act and the Families First Coronavirus Response Act require Medicare and group health plans to cover diagnostic testing related to COVID-19 at no cost to patients for the duration of the PHE. As defined by the laws, COVID-related services include:

  • COVID-19 testing
  • an in vitro diagnostic test for the detection of SARS-CoV-2 or the diagnosis of COVID-19 the test must be approved, or the developer has requested or intends to request emergency use authorization under the Federal Food, Drug, and Cosmetic Act
  • a test that is developed in and authorized by a state that has notified the secretary of HHS of its intention to review tests intended to diagnose COVID-19
  • other tests the secretary of HHS determines appropriate in guidance and
  • terms and services furnished to an individual through office visits , urgent care center visits, and emergency room visits that result in an order for or administration of a COVID-19 test items and services must be related to the furnishing or administration of the test or to the evaluation of the patient for the purposes of determining the need for a COVID-19 test.
  • Please see the Private Payer FAQ for additional information on coding COVID-19-related visits.

    What Does Medicare Permission To Contact Cover

    Medicare beneficiaries will decide how they would like to be contacted whether that may be by phone call, email, direct mail, or the form they prefer most. Medicare beneficiaries also decide the time they would like to be called and what products they want more information on.

    There are certain ways to receive permission that are ethical and others that are not.

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    Are Telemedicine Visits Paid The Same As In

    Yes if they are coded correctly. Visits must be coded according to each payers guidance. Visits that are not coded correctly may be denied or paid at a lower rate. For the duration of the PHE, CMS will pay office visit/outpatient E/M services provided via telehealth at the same rate as an in-person office visit. Additionally, CMS will pay telephone E/M services at parity with office visit E/M codes of comparable length. Payment will range from $56 to $130.

    Please see the Private Payer FAQ for additional information.

    To ensure proper payment, the AAFP recommends that practices update their billing system’s allowable amounts to reflect the updated payment rates. Claims submitted with the previous, lower amounts may not be paid the full amount, since payers often pay the lesser of the allowed amount and the actual charge.

    When Does Permission To Contact Expire

    Online Medicare Meeting in Michigan

    Permission to contact has an expiration date depending on what information the medicare beneficiary is seeking.

    For Medicare Advantage or prescription drug plans, permission to contact expires after 9 months. Medicare supplement product lines have a 90-day expiration date.

    Permission to contact MUST be established again after it expires even if ongoing contact is intended. The form of contact is also decided by the Medicare beneficiary, whether it is by phone call, email, direct mail, etc.

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    Important Medicare Guidelines Update

    Before we get into the doâs and donâts, itâs important to note that the Medicare Communications and Marketing Guidelines has undergone some changes. You can now find the Medicare Advantage and Part D Communication Requirements on the Federal Register site. The Federal Register site is straightforward and easy to navigate, so itâs never been easier to brush up on the latest Medicare marketing guidelines and updates!

    What Is Scope Of Appointment In Medicare

    Scope of appointment is a form that outlines what an agent will present to a Medicare beneficiary. Medicare beneficiaries must request information on specific plan types and only those requested plans will be covered during the presentation. Presentations can only be held after permission to contact is established.

    All one-on-one phone calls or face-to-face conversations must be preceded by a scope of appointment. All agents must keep their scope of appointments on file for at least 10 years and must be kept even if a sale was not made.

    In the event that a client would like to speak about other plan types that were not requested during the meeting then another scope of appointment is required before you continue.

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    Can I Count The Time My Staff Spends Getting A Patient Set Up For A Telemedicine Visit Toward Total Visit Time

    No. Per CPT, total time for purposes of reporting the level of service for an office/outpatient visit evaluation and management code includes the face-to-face and non-face-to-face time spent by the physician and/or other qualified health care professional on the date of service and does not include time for services normally performed by clinical staff.

    What Is A Medicare Sales Event Or Appointment

    Compliance Archives

    Sales events and appointments are defined as gatherings where a person or groups of people will be swayed towards a specific plan or plans.

    Plan specific information and collection of applications is the difference between sales events and appointments from educational events.

    During sales events and appointments, clients may still be educated as well, however, there are regulations in place from CMS that must be followed.

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    Do You Need To Renew Medicare Part A

    For most people, Medicare Part A hospital insurance is premium-free and once you have it, you wont have to do anything to keep it. If you are already getting Social Security when you turn 65, youll be enrolled automatically. If you arent getting Social Security, you can use Social Securitys website to enroll.

    There are a few good reasons not to sign up for Medicare Part A hospital insurance when you turn 65. Most of them are related to having insurance from your employer or spouses employer. Before you reject Part A, talk to a benefits counselor for your employer and make sure you understand that you are doing the right thing for you. If your situation changes and you want to enroll in Part A, do it cautiously but quickly. You can get more information to help you understand Part A rules and how they affect you.1

    Grass May Be Greener on the Other Side

    Dont take for granted that there isnt something better. Medicare is a big program with lots of options.

    What Is Medicare Permission To Contact

    Permission to contact is a rule that exists in order to protect existing or new medicare beneficiaries from medicare agents that use unethical marketing tactics. Such unethical tactics have previously made beneficiaries feel as if they were obligated to go with a specific plan all though they did not like the plan.

    This is the result of agents swaying medicare beneficiaries towards specific products that pay a higher commission. Leaving Medicare beneficiaries with a plan that does not cover the doctors or hospitals they love.

    Ethical agents need medicare beneficiaries express permission to market to them. As a great ethical agent, you must brush up on permission to contact and make sure you are compliant. Doing so provides the best results and clients that keep coming back!

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    Do You Need To Renew Medicare Part D Annually

    If you have Medicare Part D, one of the smartest things you can do is shop around during the fall open enrollment from October 15 to December 7. In most parts of the country, there are dozens of available Part D plans with different formularies, pricing, and coverage rules. Medicare enrollees in Original and some Advantage plans can check the plans networks of retail and mail-order pharmacies serving their area to find the ones that have the best deals for all the drugs they take. If you arent enrolled in Medicare.govs site for comparing plans, do that first. Then plug in the information about your prescriptions. Youll see an elaborate chart that will allow you to compare prices and availability. Run the comparison at least annually because things change regularly.

    Affordable Care Act Subsidized Plans After Medicaid

    Better Call Harry: What to do about your Medicare coverage if you move

    Special Enrollment Status: If you lose your Medicaid health coverage, a Special Enrollment Period opens up for you. During an , you can obtain full-featured health insurance known as an Affordable Care Act plan.

    The SEP is only a 60-day window, so you have to act quickly. Tools like HealthCare.com help you determine which plan is best for your needs and budget.

    Without a Special Enrollment Period, you can enroll in a health plan only during the annual Open Enrollment Period, which generally lasts from November 1 through December 15. Once the window closes, you will be unable to enroll in healthcare coverage until the next open enrollment period.

    For example, if your Medicaid is canceled as of March 1, you will have 60 days to enroll in a health plan through Obamacare. If you dont enroll by the end of that 60-day window, you will have to wait until the next open enrollment period, and the coverage would not be effective until January 1 of the following year.

    If you know when your Medicaid plan ends, you can sign up in advance. Health insurance plans are generally effective the first day of the following month after you apply, but a new application may take some time to process.

    ACA Discounts for Low and Moderate Incomes: The cost of health insurance premiums can be intimidating, but help is available. Depending on your income level, you might receive a subsidy for ACA coverage.

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    What Does It Mean To Say That Geographic And Originating Site Restrictions Have Been Waived

    The originating site is where a patient is located when they receive telehealth services. These normally must be clinical settings, such as physician offices and hospitals. Additionally, the originating site normally must be in a county located outside of a Metropolitan Statistical Area or a rural Health Professional Shortage Area located in a rural census tract to be eligible for telehealth services.

    For the duration of the public health emergency , the Centers for Medicare & Medicaid Services is waiving the geographic and originating site restrictions. Patients may receive telehealth services in any setting, including their homes.

    Rules For Meeting With An Agent

    If you’re going to meet with an agent, the agent must follow all the rules for Medicare plans and some specific rules for meeting with you.

    During the meeting, Medicare plans and people who work with Medicarecan:

    • Give you plan materials.
    • Tell you about the plan options and how to get more plan information.
    • Give you an enrollment form.
    • Collect your completed enrollment form.
    • Leave business cards for you to give to friends and family.

    During the meeting, Medicare plans and people who work with Medicare can’t:

    • Charge you a fee to process your enrollment into a plan.
    • Steer you into a particular plan.
    • Communicate incorrect information about their plan type or use inappropriate statements like their plan is “the best” or “highest ranked.”
    • Tell you about other plan options you haven’t agreed to discuss, unless you specifically ask about them .
    • Pressure you to join their plan by saying things like “you have to join this plan or you won’t have coverage next year.”
    • Ask you to give names and phone numbers or addresses so they can sell to your friends or family.
    • Ask you to sign the enrollment form before youre ready to join.

    You should only sign the form when you’re ready to join.

    After the meeting:

    • The plan will contact you to make sure you want to join and that you understand how the plan works.
    • The agent who helped you join the plan can call you to talk about other plan options.

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    There Are Two Types Of Medicare:

    • Original Medicare includes Part A and Part B. For drug coverage, you join a Medicare prescription drug plan . To pay additional costs, which can mount up quickly, most people buy a Medicare Supplement plan .
    • Medicare Advantage, otherwise known as Medicare Part C, is an all-in Medicare health plan operated by private companies that contract with Medicare to provide Part A and Part B benefits and usually, but not always, prescription drug coverage.

    Which plan you choose affects many things going forward, including how your Medicare works, what it pays for, and how easy or hard it is to switch things around.

    One of the best places to learn about Medicare is Medicare.gov, the governments information site. In order to get accurate information, you must create an account. Once youve done that, you can tailor your results. The site doesnt give you help making a decision about what is best for you, but it does offer plenty of personalized details to guide your decision making.

    What Are The Rules For Agents Who Sell Medicare Health Plans

    Plan of Care Alerts for Commercial Payers (Non

    The Centers for Medicare & Medicaid Services , which administers the Medicare program, has strict guidelines that private insurance companies must follow when marketing and selling Medicare plans. Familiarizing yourself with these rules may help you spot and avoid Medicare fraud before you become a victim.

    Avoid Medicare fraud by knowing what a Medicare agent cant do

    All insurance agents selling Medicare plans must be licensed in the state where theyre making the sale. Below are examples of illegal marketing practices and Medicare fraud.

    According to Medicare.gov, a licensed insurance agent cannot:

    • Visit you at home without your permission.
    • Cold call you unless the agent has a prior relationship with you.
    • Leave flyers or business cards at your door or on your car windshield.
    • Pressure you to enroll or switch plans.
    • Endorse a specific Medicare plan.
    • Sell you non-health related coverage during a Medicare sales call.
    • Give you gifts worth more than $15, free meals, or cash incentives to enroll in a plan.
    • Invite you to an educational event and then try to sell you a plan.
    • Enroll you in a Medicare plan over the phone .
    • Enroll you in a Medicare Supplement plan if he knows you have a Medicare Advantage plan .
    • Ask you to provide personal information, such as your Social Security number, Medicare number, credit card, or banking information .
    • Ask for referrals. You can give your friend or family member a business card, but he needs to call the agent directly.

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