Managed Care Minute
December 2021 Volume 28
Managed Care End of Year To List
 (This applies to ALL states)
It is a new year which brings a round a lot of changes to everyone including our residents. Your residents are being bombarded by information on television and radio advertisements regarding Medicare open enrollment and choosing a Medicare Advantage plan. Medicare open Enrollment was October 15th, 2021 to December 7th 2021. During this timeframe, Medicare eligible people have the option to switch from Traditional Medicare to a Medicare Advantage Plan, switch Medicare Advantage Plans or change their stand-alone Part D Plan. It is important to validate all of your resident’s insurance coverage, attain their deductibles, out of pockets and new copays as of January 1st, 2022. Something to remember: all Medicare Advantage deductibles and out of pocket expenses reset on January 1st. It is also important to notate the Medicare Advantage Open Enrollment Period, which runs from January 1st, 2022 to March 31st 2022. This timeframe allows a member that is enrolled in a Medicare Advantage plan to: switch to a different Medicare Advantage plan, drop their Medicare Advantage plan and return to Original Medicare, or signup for a stand-alone Part D Drug Plan (if they return to Original Medicare).
It is a best practice to run Medicare Verifications on ALL skilled members on the 1st and 15th of the month through April to catch potential changes.
Medicare Reminders
CMS Medicare Memo to LTC Facilities regarding Disenrollment
(This applies to ALL states)

CMS released a memo in October to all Long-Term Care Facilities regarding the disenrollment of Medicare Advantage and PACE members to traditional Medicare.  The memo can be found here.
CMS is clearly stating that “Only a Medicare beneficiary, the beneficiary’s authorized or designated representative, or the party authorized to act on behalf of the beneficiary under state law can request enrollment in or voluntary disenrollment from a Medicare health or drug plan.”
If a Beneficiary or their representative request assistance from the facility to disenroll from a plan, the facility must take steps to ensure compliance with regulations and residents rights. There are multiple steps to be adhered to, both orally and in writing to ensure compliance. State Agencies are being provided this information to monitor LTC facilities for compliance on all associated regulations.   Please review the memo and the CMS guidelines for when individuals are disenrolled from a Medicare Advantage plan or PACE program to traditional Medicare. 
When can a Medicare Beneficiary enroll in a Medicare Supplement/Medigap Policy? 
(This applies to ALL states)

Medicare Supplements, also known as Medigap Plans are insurance products designed to work exclusively with traditional Medicare. Medigap policies are exclusively tied to original Medicare. These plans vary in coverage and costs; designed to cover deductibles and copays associated with Medicare. A comparison of the different types of Supplements can be found here.

Supplement / Medigap plans only have guaranteed issue (no cost out due to prior health conditions) during a Beneficiaries initial enrollment period or during very limited Special Enrollment Periods.
A Beneficiary has a Medigap Open Enrollment Period during the first 6 months they become eligible for Medicare at age 65 or enrollment into Medicare if changing from other credible insurance coverage. After the initial 6-month window (except for Special Enrollment Periods) Medigap plans are allowed to ‘cost out’ an applicant based on their current and prior health conditions. This ‘cost out’ can result in expensive premiums and or complete lack of coverage for prior existing conditions for up to 6 months.  Medigap Policies can be confusing, if you have a question, please see the above resources or speak with your MCCFL Liaison. 
Things coming in 2022
  • Cohere for Humana PPO part B. No more Optum/Orthonet Janurary 1, 2022
  • register to learn more about Cohere and how to use the portal here
  • VA is initiating inpatient audits starting in 2022 via Cotiviti 
  • you can view this information here
Webinars hosted by MCCFL
  • PPS/UR MEETING: Hints and Tips on how to handle Manage Care admissions once in house hosted by Chris Langebrake.
  • Common Billing Errors: Come learn how to avoid common errors hosted by Nita Bolton
  • NOMNC's and Appeals: Come learn about NOMNC's and QIO appeals hosted by Nanette Johnson Smith.
Reach out to your Managed Care Liaison to get links to join webinars!
Did You Know? MCCFL Has A Client Resource Portal
We are sure you know that your Managed Care Grid and contracts area housed on the MCCFL Client Portal, but did you know that there are many more resources there as well?
Just below the Contract Grid on the main page for your center is a Marketing Sheet. This is a fully editable document that you can update with your center logo, or any other information you would like to share with your referral sources. Additionally, under the Tools tab you can choose Resources and access a treasure trove of support! Here you can find forms for things like ordering a KCI wound vac, or ordering a high-cost medication from the BCBS partner pharmacies. Jump in and take a look around the resources page to see what you can find. Please note that you have access to resources from all the insurance companies, not just those you have contracts with, so even though you see the resources you may or may not have a contract with those entities.  
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Paying Attention To The Details!
Housekeeping items...
  • As best practice we suggest reverification of all Medicare benefits on ALL skilled members on the 1st and 15th of the month to catch potential payer changes.
  • When reviewing fax authorizations, ensure to verification of dates of service are correct and authorization is for your provider's name.
  • When employees are no longer employed by a facility, please remember to remove their access to insurance portals. This practice will assist in keeping the facility HIPAA compliant. 
  • Do you need access to our client portal? Reach out to your liaison for direction.