Using Medicare Supplement Insurance to Fully Cover Medicare Gaps

DerrikKyle — Thu, 04 Mar 2010 15:27:42 +0000

The Medicare program provides healthcare coverage to approximately 44 million Americans, making it America’s largest government-sponsored healthcare program. However, even though it provides coverage for many health-related issues, Medicare often does not cover the full cost of healthcare for participants. Participants, therefore, need to be aware of what is and is not covered by their particular plan in order to ensure that they purchase necessary Medicare Supplement insurance or enroll in additional coverage plans, if needed.

In order to determine what kind of Medicare Supplement insurance participants may need, they should first determine what type of Medicare plan they currently have. There are two types of coverage plans for participants: Medicare Part A and Part B.

Gaps in Medicare Part A

Part A is known as the Hospital Insurance plan because it covers inpatient hospital fees, inpatient skilled nursing facility fees, home health fees, and hospice services. However, Part A has a significant amount of gaps in coverage that you will not be reimbursed for.

- A hospital deductible for each unique illness. In 2009, this deductible was $1,068. – Coinsurance payments for the hospital. After the deductible has been met, Plan A will cover the first 60 days of fees in full. However, for days 61 to 90, the coinsurance payment is $267 in 2009. For days 91 to 150, the coinsurance payment is $534 in 2009. – Hospital fees if a patient needs to stay beyond 150 days in the hospital. – Some coinsurance payments in skilled nursing facilities; Part A pays for the first 20 days in full. However, for days 21 to 100, the daily coinsurance payment in 2009 is $133.50. – Coverage for home health aide services that are provided on more than a part-time or an intermittent basis. – Coverage for any home health nursing or aide services where there is no skilled care.

Gaps in Medicare Part B

Part B is also known as Supplementary Medicare Insurance because it provides healthcare coverage for many physician and outpatient services that participants may need. Part B also provides coverage for many types of durable medical equipment, prosthetic devices, supplies needed to perform physician services, and even ambulance transportation. Gaps in Part B include:

- The Part B deductible. An annual deductible needs to be met before Plan B will pay for covered services. This annual deductible for 2009 was $135. – The Part B coinsurance payment of 20 percent. Plan B will pay for 80 percent of an approved charge for services and items covered by Part B. This amount, of course, varies based on the services and items required. – Any portion of a bill that is not covered by Medicare. Participants need to keep in mind that many healthcare providers charge more than the fee that is approved by Plan B. Participants will need to pay the uncovered balance.

How to Fill Medicare Coverage Gaps

When a plan participant has a coverage gap, it is often wise for the participant to fill in the gap in order to ensure that he or she has more comprehensive healthcare coverage. There are several popular ways to fill these coverage gaps, including:

- Government programs, including Medicaid, Qualified Medicare Beneficiary Program (QMB), Qualified Individual Program (QI), and Special Low-Income Medicare Beneficiary Program (SLMB). – Non-standardized group retirement policies. – Non-standardized individual Medigap plans that were issues before July 31, 1992. – Standardized individual Medigap plans that were issued after July 31, 1992.

Participants should be aware that those who are eligible to receive Medicaid will not need Medigap insurance because Medicaid will provide coverage for their healthcare expenses. However, if participants do not qualify for Medicaid but are within 100 percent of the federal poverty level, they can be covered by the QMB. QMB covers Medicare premiums, annual deductibles, and coinsurance payments.

If individuals do not qualify for Medicaid but make too much money to qualify for QMB, they may qualify for the SLMB or the QI. SLMB and QI pay for a portion of the Part B premium, so participants who receive SLMB or QI support may want to purchase Medigap insurance to help with additional costs.

All Medicare participants should be aware of the gaps in coverage that apply to them. By understanding what their coverage gaps are, they can make arrangements to enroll in programs that can help to fill all or some of these coverage gaps, which will help to ensure that they are adequately covered for their healthcare costs, no matter what happens in the future.

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How To Improve Your Medical Billing Collections Now Using These Six Important Steps

DerrikKyle — Mon, 08 Feb 2010 18:38:57 +0000

Medical billing collections is increasing in usage, as many physician practices, medical clinics and hospitals face ever-growing past due debts from slow pay patient delinquencies and backed up insurance claims. With nearly 47 million Americans not having any private health coverage, a sluggish economy caused by a recession, as well as increasing unemployment, spells diminishing positive cash flow for medical practitioners.Given that prognosis, there are a number of things you can implement to increase your internal medical billing collections. By putting these six tactics into place, you can greatly improve your financial bottom line.1. Be sure you have a clear payment procedure, placed visibly at the front of your office. New patients need to understand clearly what, if any, payment is expected upfront, in regards to co-pays, etc. This should be understood BEFORE rendering service.2. Its vitally important that you collect ample and accurate patient information during the first visit to the doctor’s office. Get the patient’s full name, date of birth, address, work, home and cell phone numbers.Get their work information: address, phone number, their title or position, supervisor/manager, etc.Obviously, the more information you can collect, the better. While some may be reluctant to give their social security number, its still a good idea, especially if the account has to be turned over to a collection agency later.3. If the patient has health insurance, its important to verify at this point. While a doctor’s office can get quite hectic, this crucial step shouldn’t be overlooked. Verifying coverage will avoid headaches later on.4. In the initial patient application, you need to detail clearly the patients’ responsibility to pay. You might also want to consider adding language that in the event the account is turned over to an outside collection agency for lack of payment, the patient will be responsible for collection costs.Some states allow the business to recoup their costs for hiring an outside collections agency. This has to be clearly stated upfront in the original patient-signed application. (Be sure to consult with your attorney about this, as state laws vary)5. Allow patients to make payment arrangements for those going through financial difficulties. Because so many are either uninsured or under-insured, making reasonable payment arrangements via installments gives them more options, and greater peace of mind. It will also help generate cash flow to your practice.6. Know when to turn over delinquent accounts to a debt collection agency. As mentioned earlier, lack of health insurance, rising unemployment and a recession has placed greater financial strains on some patients ability to pay for health care.Most people intend to do the right thing and honoring their debt obligations. But the reality is that some others are less responsible. By using the before-mentioned procedures, consistently and early on, you can better identify the patients experiencing temporary financial problems from the “problem” delinquent accounts. Payment arrangements, and continued communications can better address those problems.However, the non-paying, more difficult clients need to be identified earlier as well. These are the accounts that should be outsourced to professional collection agencies, since they are better equipped to work with these types of accounts.Failing to do so only means wasting valuable time, money and labor dealing with these difficult clients. Time is an important factor, in that the longer your account goes unpaid, the lesser the likelihood of ever getting paid. By turning these over earlier, you greatly increase your chances of at least getting some money.As a general rule, after 90 days of non-payment, medical billing collections should be turned over to a collection agency.These procedures are simple, but they’re very important. And they can prove very effective in reducing your medical billing delinquencies. If you put these into consistent practice, you will greatly improve your medical billing collections.

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Using Medicare Supplement Insurance to Fully Cover Medicare Gaps

How To Improve Your Medical Billing Collections Now Using These Six Important Steps