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Seamless Conversion to Medicare Advantage

Some questions have been raised about recent press coverage on plans enrolling new Medicare beneficiaries in Medicare Advantage without the beneficiary’s knowledge. The American Medical Association (AMA) raised concerns and a number of questions with senior officials at the Centers for Medicare and Medicaid Services (CMS). Included in this blog posting are CMS’ answers.

Ask the SFMS: Can I Bill a Medicare Advantage Patient When He/She Chooses to Seek Treatment Outside of the Network?

So, what happens if your practice sees a longtime Medicare patient who has, unbeknownst to you, switched to a Medicare Advantage plan for which your physician is not contracted? Can you bill the patient? Based on information from Centers for Medicare & Medicaid Services (CMS), the answer is yes, but with limits.

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