2. The Rural Health Clinic (RHC) program aims to provide access to primary care services for patients
living in rural areas. RHCs might be nonprofit, public, or for-profit hospitals. They must use a team
approach to provide services, with physicians collaborating with non-physician professionals such as
physician assistants (PA), nurse practitioners (NP), and certified nurse midwives (CNM). The primary
benefit of RHC classification is increased reimbursement rates for Medicare and Medicaid services. Is
your email clogged with Medicare Advantage claim denials and rejections? It is time-consuming and
stressful to investigate unpaid or refused rural health clinic claims. Let‟s go over a complete guide to
Medicare Advantage Billing to help your clinic manage healthy cash flow and reduce out-of-control
accounts receivable (AR).
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to-medicare-advantage-billing/
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A Rural Health Clinic’s Guide To Medicare Advantage Billing
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Verify the Patient’s Insurance Benefits and Check Eligibility
To prevent costly delays in claim rejections and denials, it is critical to verify each patient‟s insurance
plan information prior to their visit. Some patients may be unaware that they are enrolled in a
Medicare Advantage plan and will simply provide you with their Medicare Beneficiary Identifier
(MBI) card. As a result, verifying eligibility and benefits is a vital first step in the patient intake
process.
By establishing eligibility ahead of time, your rural health clinic can ensure
that claims are issued to the relevant payer immediately following the patient‟s visit. You may even
discover that the patient has additional vision coverage via other managed vision care (MVC) plans
that they were not aware of. A rapid eligibility check can save time as Medicare keeps a record of
reported “crossover plans,” such as supplemental coverage or vision insurance plans.
A Rural Health Clinic’s Guide To Medicare Advantage Billing
4. Follow CMS Rules When Billing Medicare Advantage Plans
Medicare Advantage plans are an “all-in-one” option to traditional Medicare plans offered by private
insurers. All Medicare Advantage plans are approved by Medicare and must adhere to CMS
guidelines for billing and coding, claim submission, and reimbursement.
Over 28 million Medicare beneficiaries will be enrolled in Medicare Advantage plans (also known as MA,
Medicare Part C, or Medicare replacement) by 2022. Beneficiaries enrolling in Medicare Advantage
programmes have more than doubled since 2007. In 2022, there will be 3,834 Medicare Advantage
plans available across the country, the most in more than a decade.
Confirm the Medicare Part B Annual Deductible Has Been Met
Medicare beneficiaries must fulfil their Medicare Part B yearly deductible each calendar year before
Medicare will issue a payment. The annual deductible for all Medicare Part B users falls from $233
in 2022 to $226 in 2023. Non-covered expenses will not be deducted from your deductible.
A Rural Health Clinic’s Guide To Medicare Advantage Billing
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5. A Rural Health Clinic’s Guide To Medicare Advantage Billing
CMS recommends that if you “accept assignment” for Medicare Part B, you do not collect the deductible
from a patient until you have received the Medicare Part B payment or confirmed the deductible has been
reached for the year. Why? It‟s more difficult to ascertain if a patient has met their deductible if you meet
them early in the year. Consider scheduling your Medicare patients later in the year, after they have
reached their deductible.
On the claim form, make a note of the coinsurance payment you collected for the covered service. Over-
collection may be considered programme abuse by CMS, and it may result in a portion of the provider‟s
cheque being sent to the beneficiary on assigned claims.
Alternatively, if Medicare Part B deems that you have been overpaid, the Medicare Administrative
Contractor (MAC) will issue you a demand letter outlining the reimbursement request.
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6. Experience Positive Cash Flow with Outsourcing
It‟s aggravating to look into rejected and refused claims. You and your in-house team can spend hours
each week analysing unpaid claims and EOBs to determine the corrective and reprocessing processes
for rejected and denied claims. Large ageing buckets cause disruption and reduce cash flow.
As a result, we recommend comprehensive proactive rural health clinic billing, patient eligibility and
benefits verification, and other revenue cycle management systems. 24/7 Medical Billing Services is
ready to help you get paid faster and increase your practice‟s financial health.
See also: Rural Health Clinic (RHC) Billing And Reimbursement
A Rural Health Clinic’s Guide To Medicare Advantage
Billing
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7. About 24/7 Medical Billing Services:
We are a medical billing company that offers „24/7 Medical Billing Services‟
and support physicians, hospitals, medical institutions and group practices
with our end to end medical billing solutions. We help you earn more
revenue with our quick and affordable services. Our customized Revenue
Cycle Management (RCM) solutions allow physicians to attract additional
revenue and reduce administrative burden or losses.
Contact:
24/7 Medical Billing Services
Tel: +1 888–502–0537
Email: info@247medicalbillingservices.com
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About 24/7 Medical Billing Services
