Becoming Eligible to See Traditional Medicare Patients at Rula

The purpose of this article is to help you understand how to become eligible to serve Medicare Fee-for-Service (i.e. “Traditional” or “Direct” Medicare) patients at Rula.

Medicare Advantage vs. Traditional Medicare

Before diving in, if you’re unfamiliar, below is a brief summary of the difference between Medicare Advantage and Traditional Medicare:

  • For both, coverage is for those who are 65 or older as well as younger people with certain disabilities. 
  • "Traditional" or "fee-for-service" Medicare is provided directly by the government to recipients. Other terms you may hear are “Direct”, “Original”, “Straight” Medicare, or “Medicare Part B” in reference to non-hospital doctor visits and outpatient care (like the ones you access through Rula). 
  • Medicare Advantage is government-funded but managed by private insurance companies – the primary difference to traditional Medicare. 

 

Requirements to see these patients at Rula

All providers working with Medicare beneficiaries 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
    • Complete the training within the Rula provider portal. Here's how! 
  2. Submit your Medicare ID / PTAN number and effective date to Rula
    • If you do not yet have a Medicare PTAN number, you can learn how to register here.  
    • If you’re already enrolled with PECOS, you can find your PTAN number using these instructions. 
    • These video tutorials are also available to help.
  3. Ensure you’re not opted out of treating Medicare clients

     
  4. Rula will help you with your reassignment of benefits

Steps to take to start receiving Traditional Medicare client referrals: 

  • #1 – 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 the articles linked above for more information about this training course and how to access it. 
      • If you have taken Rula’s Medicare training but no longer wish to see clients at Rula with Medicare coverage, start by using the AI search bar on this page for assistance. You can request a live Service Team member at any time.
  • #2 – 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.
  • #3 – Ensure you're not opted out of treating Medicare clients through CMS:
    • If you have formally opted out of treating Medicare beneficiaries through the Center for Medicare & Medicaid Services (CMS), you are ineligible to treat any Medicare beneficiaries at Rula, including patients who are utilizing Medicare Part B 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.
      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.
    • If you don’t wish to formally opt out through CMS but simply want to stop matching with Medicare patients through Rula, start by using the AI search bar on this page. You can get answers instantly or ask to connect with a live Service Team member at any time. Unlike a CMS opt-out, this status can be changed at any time.
  • #4 – Reassignment of Benefits:
    • As a final step, you will need to ensure you’ve reassigned your benefits to Rula. This is the “Reassignment of Benefits form (CMS 855-R)”, which gives Rula permission to bill Medicare for the care you provide through our platform. 
      • If you are newly enrolling and register for a new PTAN as part of step 2 and nothing further will be required (i.e. the 855-R to reassign benefits to Rula is already part of the steps you will take. You won’t need to submit an additional form on top of this).
      • If you are already Medicare enrolled and submit your PTAN to us through the form, Rula will complete, execute, and submit your 855-R on your behalf with your consent to ease the administrative burden on you.
    • This step won’t change how you get paid — it just allows Rula to bill and receive payment for Medicare claims directly. 
    • This step will not impact any existing affiliations or reassignments you may have with other organizations. For example, if you submit an existing PTAN (that you have individually or with another employer), it will not be altered or impacted in any way. You will simply receive a new PTAN affiliated with Rula at no additional expense or effort.

Once you're matched with a Traditional Medicare 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.

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