Medicare requirements

The purpose of this article is to ensure that you are compliant with Medicare requirements for treating Medicare Advantage patients. Currently, Rula only accepts Medicare Advantage coverage from the following patient populations:

  • California
    • Kaiser SoCal
    • Anthem
    • Carelon
    • Cedars Sinai (assuming risk on behalf of Blue Shield 65 HMO)
    • PIH Health (assuming risk on behalf of various MA plans)

  • Georgia
    • Anthem

Please review this article to learn more about Medicare Advantage at Rula: Medicare Advantage at Rula.

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. Here are a few things to remember: 

  • 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.
  • 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.
  • 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

Psych Referrals

Rula has expanded therapy and psych care to patients in California with Cedars-Sinai Medicare Advantage (MA) insurance through a Blue Shield plan. Inform your patients who are seeking to add psych that they must make an additional request for a psych referral from Cedars-Sinai.

 

All other Medicare Advantage patients with other insurance policies can participate in therapy only at Rula.

 

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