In December, the Medicare Open Enrollment period concluded. During this period, patients may have made changes to their Medicare coverage, such as switching from traditional Medicare to a Medicare Advantage Plan. As we enter the new year, it is crucial to conduct a new Eligibility Verification Run for every patient on your census in both Home Health and Hospice. This will ensure that the correct payer is billed for patient care.
For Hospice agencies, there have been updates to the Value-Based Insurance Design (VBID) demonstration. Some plans have been removed from the demonstration while others have been added. If your patient was in the VBID model on December 31st and remains a patient in 2024, the VBID model plan they were part of must continue paying for Hospice expenses until the patient has deceased or discharges.
If you were billing traditional Medicare on December 31st, and a patient transitions to a new VBID plan in 2024, you will continue to bill traditional Medicare. A patient would go under the VBID demonstration once they were to live discharge, and then be readmitted to Hospice.
For Home Health agencies, payers are a significant factor in ensuring proper payment. It is highly recommended to conduct Eligibility Verifications on your existing patients throughout the month of January, ideally on a daily basis. While some EMR Systems now automate this process, there are instances where agencies do not even review the reports. This negligence is very dangerous.
Be sure to check any available reports in your EMR systems to check if there have been payer changes, and make sure they are noted and addressed. If your EMR system does not automatically perform these checks, it is highly recommended that you conduct Eligibility Verifications on patients aged 65 years or older at least once a week during the month of January.
As we continue into 2024, the growth of Medicare Advantage has been significant. Approximately 50% of patients being Medicare eligible are participating in a Medicare Advantage Plan. Additionally, patients who elect to participate in a Medicare Advantage Plan can also switch from one plan to another without your knowledge.
While conducting eligibility verifications, it is important to ensure that your clinical staff, who are in the homes with patients, ask them relevant questions. They should inquire if there have been any health insurance changes for 2024, if they have received any new cards in the mail, and other relevant questions. This proactive approach allows you to obtain information about any changes that may not be reflected in the Medicare Verification System yet.
Should you have any questions regarding the Eligibility Verification process at your agency, please feel free to reach out to us.
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