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Should You Contract with Medicare Advantage Insurance Plans

Medicare Part B vs. Medicare Advantage: Medicare Part B is traditional Medicare that covers outpatient therapy services. Once contracted with Medicare Part B, providers can deliver services in a clinic they own, rent, or lease, or in the patient's home. Medicare Advantage (Part C) is an alternative to Medicare Part B. Beneficiaries can't have both Medicare Part B and Medicare Advantage; they must choose one or the other. Working with Medicare Advantage: If a provider is contracted with Medicare Part B, they can treat Medicare Advantage beneficiaries under certain conditions. If the Medicare Advantage plan has out-of-network coverage, the provider can treat the individual and submit a claim on their behalf, but they are limited to what they can collect to what the plan allows. If the Medicare Advantage plan is an HMO, the provider can treat the individual, but they can't submit a claim because they won't be covered as an out-of-network provider. However, they are not limited to what the plan allows and can charge their full cash rate or their prompt pay discount. Deciding to Contract with Medicare Advantage: Contracting with Medicare Advantage plans broadens the scope of patients providers can see and bill for. However, this is only beneficial if the provider has the infrastructure to handle more patients and more patient referrals. For a sole practitioner without an administrative team, it might not be worth contracting with Medicare Advantage plans because there are enough traditional Medicare Part B patients to keep them busy. Building a Business: If a provider wants to grow, scale, and build a business that they can sell in the future, they might consider contracting with Medicare Advantage plans. However, if they're focused solely on being the best physical therapist and not on building a medical billing and insurance credentialing business, they might stick with self-pay patients and traditional Medicare Part B. Recommendation: For small operations or single owner operators, it's probably not worth going through the contracting process with Medicare Advantage. They should let those patients see in-network providers, and if the patients still want services that only they can deliver, they can pay out of pocket and see them for the specialty. Article: https://www.choosept1st.com/blog/shou... ✔️ If you would like to learn more about Medicare billing please join our FREE Facebook community at Medicare Billing for (Mostly) Cash Based PT, OT, SLP ✔️ If you are interested in learning more about billing Medicare check-out our website at Learn Medicare Billing ✔️ And if you just want to learn more about me 😀 check-out my Facebook profile. If you would like to mail me: Total Therapy Solutions 5900 Long Meadow Dr Middletown, OH 45005