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Understanding Medicare Advantage Plans
Speaker: Bill Finerfrock, HBMA Legislative Consultant
This program discussed the types of Medicare Advantage Plans – traditional HMO, PPO type plans and private fee-for service plans and how the insurance structure affects patient coverage, service billing and provider reimbursement.
- What is different than “regular” Medicare?
- Are the MA plans required to provide the same coverage as the “Other” Medicare?
- How much leeway do the MA plans have to change the rules?
- The overall plan requirements from a National perspective Limiting charges vs. fee schedule limits
- In-network vs. out-of-network payments
- Determining risk areas for a practice to be considered a participating Medicare Advantage provider
A link to the Medicare Managed Care Manual is provided and was briefly discussed during this Webinar as well.