*PLEASE NOTE: Due to speaker emergency, this live session is being rescheduled.
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 Heidi Kocher, JD, can help. Heidi 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 upcoming 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.
Heidi has 20 years of experience in health care legal and compliance related issues. Her experience includes positions at a large hospital corporation, serving as a compliance officer for a sleep lab/DME company and a compliance director, chief privacy officer and interim chief compliance officer at a medical device manufacturer.
In addition, she has represented and advised critical access and long-term care hospitals, physician groups, home health agencies, DME companies, pharmacies (including compounding pharmacies), non-profit organizations, and licensed individuals. As a result, she understands the complexities and challenges that providers large and small face in complying with increasingly varied and complex laws.
She is an expert in all aspects of compliance and privacy programs, including developing and deploying policies, procedures and training. Her experience includes implementing the various requirements and aspects of a Corporate Integrity Agreement, responding to and defending audits from Medicare, Medicaid and private insurers up through the ALJ level, guiding clients through voluntary self-disclosures, seeking advisory opinions from the OIG, and defending FDA audits.
Heidi developed criteria for and implemented an aggregate spend system, permitting a medical device manufacturer to timely report correct information under the Physician Open Payments Acts (also known as the Physician Payments Sunshine Act).
In addition, she is experienced in developing and implementing a compliance program to address Foreign Corrupt Practices Act requirements, including Eucomed guidelines. She also has significant reimbursement experience, addressing coverage policy issues, challenging denials, recoupments, and loss of billing privileges, obtaining HCPCS codes, and other reimbursement related issues.