Help: FAQs, tutorials, videos, page index and more
Viewing:  Mar 18, 2019

Medicare Advantage Providers are not Required to be Enrolled in Medicare

By:  Wyn Staheli, Director of Research
Published:  December 18th, 2018

There was a ruling that was requiring providers to be enrolled in Medicare in order to provide services for Part C (Medicare Advantage (MA)) and/or Part D. However, on April 2, 2018, CMS released the 2019 Final Rules for MA and Part D which changed this previous ruling. According to a CMS press release (see References below), as part of the  “Patients Over Paperwork” Initiative, effective January 1, 2019, they are “eliminating enrollment requirements for healthcare providers and prescribers that bring value to Medicare Advantage and Part D beneficiaries.” This is only for Part C and Part D plans. For Part A and Part B, it is still necessary to be enrolled as a Medicare provider. Healthcare providers who have opted out of Medicare may now provide services to beneficiaries under Medicare Part C or prescribe Part D covered drugs.

This doesn’t mean that ANY provider can now start providing services for Part C beneficiaries. Medicare Advantage plans will utilize a “Preclusion List” to ensure that excluded providers are not eligible to provide services to Medicare beneficiaries. This list is not the same thing as the OIG Exclusion List. However, if a provider is already on the OIG Exclusion List, there’s a high probability they will also be on this new “Preclusion List”.

Also, in many cases, Medicare Advantage (e.g., HMO, PPO) plans require providers to be enrolled in their plan to be an in-network provider before they will cover services. Be aware of individual payer policies.


References:

###

Article Tags:  (Click on a tag to see related articles.)



Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.

Our contact information:

Find A Code, LLC
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Fax: 801-770-4428
Email:
Free 28 Day Trial
No Credit Card Required
Pricing
Starting at $10/month
Sign In
Welcome back!