Medicare Advantage Plans: Frequently Asked Questions

There has been a lot of discussion on Medicare Advantage plans lately on several of the social media platforms. While social media can be a good place to seek information, the information that is shared is not always correct or perhaps, not correct for your specific situation and/or question. In this article, I will provide answers to the following questions I am routinely asked:

1. Does the annual therapy threshold that applies to traditional Medicare beneficiaries also automatically apply to all Medicare Advantage plans and their beneficiaries?
2. Does the 10th visit Progress Report that applies to traditional Medicare patients also apply to all Medicare Advantage plans and their respective beneficiaries?
3. I know traditional Medicare requires a dated signature of the physician or nonphysician practitioner (NPP) whom the Medicare beneficiary is under their care while receiving outpatient physical, occupational and/or speech therapy services. Does this same requirement apply to Medicare Advantage plans whose beneficiaries are receiving outpatient physical, occupational and/or speech therapy services?
4. Do the traditional Medicare supervision requirements of therapy students also apply to Medicare Advantage plans and their respective beneficiaries?
5. Does traditional Medicare’s “8-minute rule” automatically apply to all Medicare Advantage plans?
6. Must Medicare Advantage plans cover maintenance therapy in the same manner that traditional Medicare covers maintenance therapy?
7. If I am not in-network (not enrolled) with a Medicare Advantage (MA) plan, can I charge the patient my cash rate and just provide them with a bill or invoice that they can then submit to the MA plan and obtain whatever reimbursement the MA plan will reimburse them?
8. If a Medicare Advantage (MA) plan is an HMO and we are enrolled with traditional Medicare, is the MA plan required to allow Medicare enrolled providers to treat their clients and pay for those therapy services?
9. Does the impending 15% payment reduction for services provided in part or in whole by a physical therapist assistant or occupational therapy for traditional Medicare also apply to Medicare Advantage plans?
10. If I am not enrolled in traditional Medicare, can I treat Medicare Advantage patients whether I am in-network or out-of-network?

Lets begin!

Question
Does the annual therapy threshold that applies to traditional Medicare beneficiaries also automatically apply to all Medicare Advantage plans and their beneficiaries?

Answer

Question
Does the 10th visit Progress Report that applies to traditional Medicare patients also apply to all Medicare Advantage plans and their respective beneficiaries?

Answer

Question
I know traditional Medicare requires a dated signature of the physician or nonphysician practitioner (NPP) whom the Medicare beneficiary is under their care while receiving outpatient physical, occupational and/or speech therapy services. Does this same requirement apply to Medicare Advantage plans whose beneficiaries are receiving outpatient physical, occupational and/or speech therapy services?

Answer

Question
Do the traditional Medicare supervision requirements of therapy students also apply to Medicare Advantage plans and their respective beneficiaries?

Answer

Question
Does traditional Medicare’s “8-minute rule” automatically apply to all Medicare Advantage plans?

Answer

Question
Must Medicare Advantage plans cover maintenance therapy in the same manner that traditional Medicare covers maintenance therapy?

Answer

Question
If I am not in-network (not enrolled) with a Medicare Advantage (MA) plan, can I charge the patient my cash rate and just provide them with a bill or invoice that they can then submit to the MA plan and obtain whatever reimbursement the MA plan will reimburse them?

Answer

Question
If a Medicare Advantage (MA) plan is an HMO and we are enrolled with traditional Medicare, is the MA plan required to allow Medicare enrolled providers to treat their clients and pay for those therapy services?

Answer

Question
Does the impending 15% payment reduction for services provided in part or in whole by a physical therapist assistant or occupational therapy for traditional Medicare also apply to Medicare Advantage plans?

Answer

Question
If I am not enrolled in traditional Medicare, can I treat Medicare Advantage patients whether I am in-network or out-of-network?

Answer

I hope you found the answers to the questions helpful. If you have an additional question(s) regarding Medicare Advantage plans, email me at info@gawendaseminars.com and perhaps your question and my answer will be added to this article. Thank you for being a Gold Member!

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