Medicare requirements

Ensure you are compliant with Medicare Requirements for the treatment of Medicare Advantage patients

All providers who will work 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: these include training on Fraud, Waste, and Abuse as well as General Compliance. Rula’s provided Medicare Training covers both of these requirements.
    • 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, like other payors, requires documentation of the services you are providing to their members. It is especially important to thoroughly document the services you are providing 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 for 2 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

On the Medicare Population

Medicare beneficiaries primarily consist of people over the age of 65 but also include some people who are under 65 with certain conditions or disabilities. These patients can encounter a limited pool of providers as not all providers are eligible to treat Medicare beneficiaries or bill Medicare for services. Expanding our services to this patient population is a continuation of Rula’s mission to make mental healthcare work for everyone. Thank you for working with us to provide critical care to these patients!

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.

 

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