Even innocent mistakes when billing for patients with both Medicare and Medicaid coverage can quickly lead to a costly legal nightmare for your practice.
There is a fine line between getting it right or violating the complex federal and state regulations you are required to comply with. Nearly 20% of Medicare beneficiaries also have Medicaid coverage. Meaning that dual-eligible claims occur pretty regularly and can represent a significant chunk of your reimbursement.
Billing Medicare or Medicaid individually is confusing enough, but when you put them together, the complexities expand exponentially. For example, it is essential that you bill the correct plan first, and know which of your normal processes, like collecting copays, can actually send up alarm bells for federal and state auditors.
Fortunately, legal expert Owen Dahl, LFACHE, CHBC, LSSMBB, can help. Owen is presenting a 60-minute online training that will walk you through each step of how you can comply with these confusing dual-eligible regulations. This training will focus on what practices like yours need to know to avoid running afoul of the laws surrounding these complex state and federal regulations.
Here are just a few of the easy-to-implement dual-eligible compliance strategies you’ll receive by attending this 60-minute online training session:
- Correctly determine primary coverage (Medicare vs Medicaid), every time
- Master how to differentiate dual-eligible patients from Qualified Medicare Beneficiaries (QMBs)
- Calculate when you can (and can’t) charge dual-eligible patients
- Differentiate “partial duals” from “full duals,” and avoid easy-to-make mistakes
- Implement compliant processes for QMB patients and prevent sanctions
- Uncover requirements if you don’t actually participate with Medicare or Medicaid
- Accurately identify and bill when patients are partially dual eligible
- Head off balanced billing errors with proven front desk tracking system
- Stop errors when QMB patients also have Medicare Advantage or commercial insurance
- Pinpoint and comply with additional state law requirements governing dual-eligible patients
- Implement correction for accidentally billing QMBs, to avoid financial penalties
- And much more!
WARNING: The simple mistake of confusing a dual-eligible patient versus one that is part of the Qualified Medicare Beneficiary (QMB) program can turn into a compliance disaster. For example, the very act of charging QMBs any cost-sharing amounts could lead your practice to face fines, exclusions, and other sanctions—even if the bill is only for a few cents. You don’t even have to collect coinsurance to be subject to fines—just asking a QMB patient for the money can get you into serious trouble. This upcoming training will help you differentiate the two and protect your practice.
Don’t leave your practice open to accusations of impropriety when it comes to billing for dual-eligible and QMB patient services. By implementing a few process modifications, your practice will better identify these patients and process their claims compliantly, keeping you in the clear.
Sign up today for this expert-led training to ensure that you get paid for the services you provide to both QMB and dual-eligible patients without violating their complex rules. Don’t wait to register. Access to this training is limited to ensure that there is time to answer all attendee questions.
Owen is a principal of Owen Dahl Consulting, in The Woodlands, Texas. He has 53 years of experience in consulting, running a medical billing service and managing medical practices. He was also a hospital administrator. Owen speaks across the country on medical practice issues related to strategic planning, Lean and Six Sigma, culture, human resource management and the revenue cycle.
He is an adjunct professor at the University of New Orleans, the author of Think Business – Medical practice quality, efficiency and profit, contributing author of the popular book Lean Six Sigma for the Medical Practice and recently published Integration of Behavioral Health Into Medical Homes: A Rapid Implementation Guide. Owen received his Bachelor’s degree in Hospital Administration at Concordia College, Moorhead, MN and his Master’s from the University of Northern Colorado. He recently achieved his Lean Six Sigma Master Black Belt through Villanova University. He served in the USAF.
I think the speaker is very knowledgeable. I liked how Owen brought certain information to our attention specifically, what to look out for. In addition, he made lots of suggestions on how to train our staff which will help guide us.
Iris Quintana
Office Manager, Valley Health System
