Page 13 - Mobility Management, January/February 2021

widespread example: Electronics E2377, E2311 and E2313 are frequently being denied as not medically necessary.
Providers need to be aware of these other ways Medicare Advantage Plans can provide more for less
while incurring the costs of all those celebrity commercials. This other
way squeezes the CRT supplier, and
it impacts access as more and more suppliers are saying no to contracts or customers with one of these plans.
What Can You Do?
First, review all contracts thor- oughly and make sure they’re clear regarding what the Medicare Advantage Plans will pay and how they pay (rental/purchase). Don’t just accept “We follow Medicare” assertions; that doesn’t mean the
Medicare Advantage Plan follows Medicare’s payment rules, since they are not required to per CMS. If you can’t accept what they offer, don’t accept it. Try to negotiate a fair contract, and if the Medicare Advantage Plan won’t accept your terms, don’t accept the plan.
Second, educate your customers (current and new) on where they can obtain unbiased information on the differences between original Medicare and Medicare Advantage private plans. If you can’t accept customers with Advantage Plans, tell them why.
Beneficiaries are only hearing from celebrities promoting these plans — they’re not hearing how these plans negatively impact beneficiaries’ medically necessary benefits with unsustainable prices and payment methods (such as 13-month rentals
for Complex Rehab power chairs and accessories). While the Medicare Advantage Plan customer may get
a gym membership, they may not
be able to obtain the wheelchair
they need. Tell them they can select original Medicare FFS (or switch back) if they find that Medicare Advantage Plan isn’t as good as those celebrities made it appear.
Finally, tell Medicare recipients struggling to make sense of all these plans and sales pitches that they can call (800) 633-4227 (1-800-Medicare) to speak to an actual Medicare representative for accurate, unbiased information about selecting the best plan for them. m
Dan Fedor is Director of Reimbursement & Education for U.S. Rehab/The VGM Group
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