About LASHUNDA Expertise Billing,Claims, and resolutions to the following insurance agencies: Medicare, Medicaid, Coordination of Benefits, Most Managed Care such as HMO's, PPO's, Medicare Advantage Plans, Governmental Agencies such as Work Comp and Veteran's Administration. I would like questions that are in regards to Billing and Collections from Insurance Companies. I can also accept some questions regarding accounts sent to Medical Collections. Please be advised that I reside in Texas and most of my knowledge is based on how it works in Texas.
Experience I have worked in the Medical field for 15 years. I currently help to coordinate contracts for a physician group in Texas. I am extremely good with resolving issues with commerical insurance companies. I'm an expert in coordination of benefits between Medicare and Commercial insurance companies.
Question We are seeing more and more of our home health patients switch from either
straight Medicare to HMO coverage( medicare replacement plans) or from
HMO to HMO mid cert period. months later when payment is rejected by
Medicare we find out they have changed. THis has caused us to discharge (
OASIS MD notification etc) from either Medicare or the initial HMO and
readmit ( authorization to treat, SOC paperwork , new cert dates which
change all recert dates etc) to the new HMO. Is there any way to not drown
our MDs, patients, and selves in paperwork just because they changed
payment sources?
Answer Hi Lori. Thanks for the question. I think we are all experiencing changes in healthcare. From you question, I'm not sure if you guys are hospital providers or a physician practice. However, here is what I can tell you...trying to avoid the attack of paperwork just doesn't happen these days. Usually, when a patient changes Medicare Advantage Plan (or MAPs as they are called) the effect doesn't happen immediately. It usually takes about 45 to 60 days. Change the way you ask about insurance. If you are asking for the patient's insurance card, that's good but it doesn't necessarily mean that's the insurance they have or is trying to obtain. Here's a few good questions..."Do you have your insurance cards with you today?". "Have you submitted a letter to terminate this plan within the last 45 to 60 days?" "Do you like your plan and do you plan to stay with this insurance?"
I know this sounds like you should be working as a Social Worker or Financial Assistance however you have to remember...we are working with Seniors who never really got a full understanding from MAPs other than the following:
You can get a drug prescription benefit with these plans.
You may not have to pay a premium because the ins co will reimburse you for your Medicare premium.
All you have to pay is a copay.
You can switch to another plan if you don't like it.
So your questions have to be direct and to the point so that they can understand that you are trying to make sure they are hassled less.
