Medicare Advantage Requirements at Rula

The purpose of this article is to ensure that you are compliant with requirements for treating Medicare Advantage patients.

Requirements to see these patients at Rula

All providers working with Medicare beneficiaries through Medicare Advantage plans must meet the Center for Medicare and Medicaid Services (CMS) requirements for treating these patients. 

Summary:

1. Complete your Rula Fraud, Waste, and Abuse and General Training
2. Submit your Medicare ID / PTAN number
3. Ensure you’re not opted out of treating Medicare clients

Steps to take to start receiving Medicare Advantage client referrals:: 

• Fraud, Waste, and Abuse and General Compliance Training:
  • One of the requirements for working with these Medicare beneficiaries is to complete CMS’ required training, including training on Fraud, Waste, and Abuse and General Compliance. Rula’s provided Medicare Training covers both of these requirements.
    • Please review this article for more information about this training course and how to access it: Accessing Fraud Waste and Abuse course to see Medicare clients.
    • If you have taken Rula’s Medicare training but no longer wish to see clients at Rula with Medicare coverage, you can email support@rula.com.
• Medicare ID / PTAN:
  • Once enrolled, therapists will also be required to share their Medicare ID/PTAN number and effective date with Rula.
  • Medicare ID/PTAN can be submitted to Rula using this form.
    • For more on registering for a new PTAN using the PECOS platform see this resource.
    • For more on where to find your existing PTAN information, see this resource.

Once you’re matched with a Medicare Advantage patient:

• Documentation:
  • Medicare, like other payors, requires documentation of your services to their members. It is especially important to thoroughly document your services to Medicare beneficiaries, including ongoing medical necessity, treatment plans, patient progress, and other clinically relevant information.

Opting Out of Treating Medicare Clients

• If you have formally opted out of treating Medicare beneficiaries through the CMS, you are ineligible to treat any Medicare beneficiaries at Rula, including patients who are utilizing Medicare Advantage (Medicare Part C) plans
  • Therapists who wish to formally opt out of participating in Medicare must do so formally through CMS. For more information on Medicare and the opt-out process, follow this link.
  • If you wish to opt-out informally (at Rula only and not through CMS), please email support@rula.com. This status can be changed at any time.
  • Formally opting out of Medicare through CMS lasts two years and generally cannot be terminated early. 
  • During the opt-out period, the therapist may only treat Medicare beneficiaries through private contracts directly with the patient and may not provide any treatment to patients using Medicare benefits, including Medicare Advantage

Unsure if you’ve previously opted out of Medicare? To check, you can use the "Provider Opt-Out Affidavits Look-up Tool" on the CMS Data website, which allows you to search for your name to see if your provider status is currently listed as opted out; you can also contact Medicare directly through their phone number at (800) 633-4227 to verify your enrollment status.