Medicare Open Enrollment is currently active and will allow patients to join a Medicare Advantage plan, to switch from one Medicare Advantage plan to another, and to switch from a Medicare Advantage plan back to traditional Medicare. There are many changes that will occur during this open enrollment period with the anticipation that any changes that do occur will go into effect January 1, 2023.   

Keep in mind that many agencies as well as patients may be unaware of what has transpired with their coverage. Ensure you are communicating with your field staff about being aware of any new information from their patients about their health coverage. Your clinicians need to have conversations with their patients to find out if they have letters, new cards, or other items regarding their health care coverage and that they should make sure they report it to the office. 

For Hospice, the VBID model that began two years ago is in full swing. There will be 119 benefit packages under the Medicare Advantage plans participating in the VBID demonstration for Hospice starting January 1, 2023. Instead of only checking for Medicare Part A coverage, as hospices have done historically, you must now be very detailed.  If the patient has any Medicare Advantage coverage, go through the details to determine whether the patient’s plan is involved in the VBID demonstration. If it is, you will have to bill both traditional Medicare, and the Medicare Advantage plan for payment for the Hospice services. 

The recommendation to all agencies is that you should check all patients’ Medicare eligibility for at least the first three months of the new year: January, February, and March at least two to three times in that period. Changes that occur during open enrollment do not always show up in the Medicare system as quickly as we would like it to. 

If the system is not updated in a timely manner, and when you checked the status and it was not present, you will be able to get exception if there have been any penalties that might have occurred with billing, but you do have to be able to prove that the changes were not in the system when you checked. Keep a copy of the eligibility verification of your patients as you are checking them, and it is recommended you do that throughout the year, not just in those first three months of the year. 

If you have any questions or need assistance, don’t hesitate to reach out and contact us. We are here and ready to help.