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Medicare coverage gaps shortened in 2023

On Behalf of | Jan 17, 2023 | Medicare & Medicaid Fraud

In the fall of 2022, the Centers for Medicare & Medicaid Services issued a final rule on implementing several changes in Medicare enrollment and eligibility that will reduce gaps for Texas residents when first signing up for Medicare. Special enrollment periods and extending coverage of immunosuppressive drugs for certain patients are among with four key charges.

What are the four Medicare rule changes?

The Consolidated Appropriations Act of 2021 prompted these Medicare and Medicaid law changes. Significant changes include:

  • Shortening the time between enrollment and coverage for individuals who enroll during the last three months of their initial Medicare enrollment period
  • Those who sign up for Medicare after missing their initial enrollment period will receive coverage beginning on the succeeding month instead of waiting until July 1
  • Five new special enrollment periods creating for individuals facing certain circumstances
  • Part B immunosuppressive drug coverage is now extended to certain kidney transplant patients who would otherwise lose coverage under Medicare

The Special Enrollment periods are particularly notable for individuals who may have missed the initial enrollment periods because they retained insurance coverage from their employer, have been in prison, delayed applying because of a natural disaster, or lost Medicaid coverage.

Getting the compensation your practice deserves

The Medicare rule changes should also shorten or eliminate the grey area for billing when older patients switch from traditional health insurance to Medicare and Medicare supplements. Medicare billing reimbursement is often complicated due to government regulations. It’s in your best interest that your practice’s billing department is up-to-date on the latest changes.

Additionally, ensure your office has compliance measures for billing and claims determination in place so you continue to receive Medicare payments when servicing older patients. Not following proper procedures can result in the temporary suspension of Medicare reimbursements.