decisionhealth Newsletters, Part B News - 1999 Issue 6 (June)
Medicare HMO patients pose cost risk for FFS physicians
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Article Overview
This article discusses Medicare managed care and fee-for-service payment risk for physicians who see patients enrolled in a Medicare HMO. It explains the general payment context, why claims may not be covered by Medicare or the plan, and why physicians and billing staff should understand beneficiary responsibility and waiver-related issues. The piece is relevant to clinicians, office managers, and medical billing professionals working with Medicare enrollment and coverage questions.
Why This Topic Matters
Understanding managed care enrollment status can help practices avoid unexpected nonpayment when treating Medicare beneficiaries outside their plan arrangement. The article highlights a common coverage and billing concern for offices that see both fee-for-service and managed care patients.
What You Will Learn
- How Medicare managed care enrollment can affect payment responsibility
- Why care delivered outside a Medicare HMO may create billing risk
- Which practice settings and staff may need to be alert to beneficiary payment arrangements
- How coverage questions differ for routine care versus limited exceptions discussed in the article
Who Should Read This
- Physicians
- Medical billing staff
- Practice managers
- Coding professionals
- Revenue cycle staff
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