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Top Questions from the Medicare Advantage Update Webinar

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Medicare Advantage Update Webinar Questions

Olga Barone-AllanMeliza Weiner

 

 

 

 

 

 

 

Looking for more information about Medicare Advantage? BESLER’s Olga Barone-Allan and Meliza Weiner answer your questions from the recent webinar. 

To watch the related Medicare Advantage Update Webinar, click HERE


 

    1. How are organ transplants paid?

      Coverage is based on the individual payor plans.

    2. Are they all covering bathroom safety items? This has not historically been the case. Correct, it has historically not been the case. Coverage is based on the individual payor plans.
    3. Transfer DRG question: Hospital A discharged patient Home (as ordered & documented). Claim returned indicating the same patient received Home Health Services within 3 days of discharge. Does Hospital A change the dc status to Home Health (06) even though it does not match documentation?

      Thank you for your question, and it is a common dilemma. The recommendation and the right thing to do is to change the discharge status knowing that the claim was returned due to home health providing services and documenting that the change occurred after discovering home health was arranged and provided after discharge. This helps with future audits conducted by CMS/OIG.

    4. And it may be that a Transitions Team arranged home health after they left hospital. So, they really did leave without but had home health quickly arranged after discharge.

      The transitions team should document that home health was arranged after the patient was discharged. If an audit occurs, documentation will be in place and will show that the change occurred after discovering home health was arranged and provided.

    5. Can you speak to how the MA plans establish network adequacy? Do you know who to contact at CMS in regard to network adequacy issues?

      The Medicare Advantage Network Adequacy Review overview is available on CMS’s official website. There are links that provides information about the standards and regulatory requirements related to network adequacy reviews set forth at 42 CFR 422.116.

 


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