Important Medicare Open Enrollment Reminder
Provider open enrollment is here. Learn why Medicare status matters, how to avoid accidental termination, and what steps you must take now if you plan to change your enrollment for the year ahead.
Transcript:
Marc:
We hope you are all having a fantastic week, and Brandy Brimhall has joined us again and again. She is with Practisync. She is our chief operating officer over billing operations and handles Practisync’s billing and the billing team that does phenomenal work, and is actually a wholly owned subsidiary of the Illinois Chiropractic Society. But Brandy is here today, and we’re going to talk about your, as a provider, open enrollment for Medicare, and what that means, and what you have to do if you have to do anything, or what you need to do if you want to make some changes there. Brandy, what do you see in this world with the providers that you help?
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Brandy:
Got it, so the first thing, really, just to relay the foundation that hopefully all of us know, is that as a chiropractic provider, you are obligated to be enrolled with Medicare one way or another if you’re going to see Medicare patients. So that means you’re going to be either participating or non-participating. Certainly, if you have questions on that, let us know, and we’re happy to answer them. But on the front of open enrollment, what that ultimately means is, if you are already an enrolled provider, so you’re either participating or non-participating with Medicare, and you think, you know what, I want to change my enrollment status. I’m par, but really I would be better off to be non-par or vice versa. You have only one opportunity every single year in order to make that enrollment status change for yourself.
That is the open enrollment period for providers, which opens roughly mid-November and goes through the end of the year every single year. So if you’ve been thinking about it, and if that’s something you want more information on, or if you want to make that change, now is your opportunity to make that change for this year, so that you can have that different status going into 2026. With that being said, I want to just double clarify that if you’re not already enrolled with Medicare at all, you can enroll with Medicare at any time and make that decision to be par or non-par. But if you’re already enrolled and want to change your status. That’s the open enrollment that we’re coming upon right now. That’s open to the end of the year.
Marc:
Yeah, a couple of things I want to throw in here, too, just based on conversations that I have with doctors. And the first is, I want to reiterate again what she said right at the beginning. Opting out is not an option. You cannot private contract with a Medicare patient. If you are seeing a Medicare patient, you must be enrolled with Medicare so you have, I would say you have three options. Brandy, I think you covered two of them, right? One is that you can be a participating provider. You can be a non-participating provider, or you can see no Medicare patients. And that’s super important, by the way, that also bleeds over to Medicare Advantage patients. So the rules don’t change Medicare Advantage. Although the rules are completely different, they actually do require that you are enrolled with Medicare in that Part B world, because they actually use that part, your Part B status, your enrollment status with Medicare, as a key way to determine how to process claims. But you can’t see, so that’s super important. You know?
The other is, is how often that you change and just make sure that you’re enrolled the way that you need to be. I would also encourage you to do this, make sure that you’re submitting claims, even if you know that the claims are not going to be covered. So we have some functional medicine doctors who don’t who see some Medicare patients, right? And they won’t bill Medicare for an extended period of time. And what has happened is Medicare will unenroll you because you’re not submitting claims. But then you have to rewind to what both of us just said, which is, you have to be enrolled with Medicare, right? So you want to make sure that you don’t have that happen. So we recommend that at least once a month, go ahead and submit a claim, allow Medicare to reject that and just make sure that that claim is processed appropriately. Does that make sense? Am I covering my bases there well, Brandy?
Brandy:
100% and I think it’s really good to even clarify that. You know, Medicare has the one-year timely filing, and that has been misinterpreted a little bit as one year to submit claims, but Medicare will actually automatically terminate enrollment after six months of inactivity. So you’ll just get a letter telling you you’re no longer active, or you’ll try to submit, and it’ll say you’re not an enrolled provider. So, just to your very point, even if you’re low volume, submit once a month or once every other month, but make sure you have activity, because the lack of billing activity after six months will cause you to be immediately terminated from enrollment, and then you have to start all over.
Marc:
Yeah, and it’s a pain, and there’s a long delay, and it’s a challenge, and some doctors are having trouble getting back in that realm. I will tell you, this isn’t a hypothetical. I want you to know that I have taken no fewer than three, maybe four phone calls on this exact issue in the last six months, and so it’s a hot topic right now. Make sure that you’re submitting claims, because, again, even if you’re functionalist and even if you are not billing Medicare for any covered services, so there’s no. Final adjustments that you’re billing for whatsoever. It doesn’t matter you can’t see that Medicare patient if you’re not enrolled with Medicare. The other thing I would touch on is handling the enrollment. I get this question: Should I do it online, through Picos, or should I do paper? I think this one’s super easy. Don’t do paper. I can’t. There might be instances where that would happen, but I would encourage you, if you’re at that stage, you’re probably going to need professionals to help you get that taken care of, and Brandy will talk about that here in just a minute, I’m sure. But make sure you do it electronically, because the processing time is substantially faster when you’re enrolling or changing your status through the Picos system, right?
Brandy:
Absolutely, and it’s easier to check the status of your application if you have to get a new document to them or something that they’ve requested. It’s easier to just upload it, submit it right there. So it does make the process so much faster and more efficient, and you have far less risk of issue and error because those paper documents, Medicare is unimaginably particular about everything. On the Picos portal, when you’re going through that, you have a much lesser chance of goofing something up or skipping a required field, that kind of thing, where the paper forms, there are so many pages, it’s so easy to overlook something and have an incomplete application, which ultimately gets dumped. So use the picos. The electronic way is definitely the more efficient way to go about it.
Marc:
And here’s the other thing is we’ve run into this as well, where doctors have run into roadblocks. They’ve run into some challenges, things that they haven’t been able to figure out. And Brandy, I assume you’ve got some potential help for that. And again, in those cases, it is going to be worth hiring a professional to help you navigate those challenges. I’ve seen some doctors hesitate and keep procrastinating and putting off hiring their professionals. We had one that actually put it off for about six months and lost all the revenue for that six months because they didn’t have the right help. And so sometimes we throw the baby out with the bathwater. So Brandy. Who would you point them to in this regard, to get some help?
Brandy:
I would send them to Rapid Credentialing. You can visit the website at rapidcredentialing.com, or you can send an email to sales@rapidcredentialing.com, and someone will reach out to you. And with that being said, just to quickly reiterate, it could be that you’ve been removed from Medicare, you’ve been terminated, and you need to reactivate or re-enroll. They’re able to help with that if you’re not able to do that yourself. Medicare doesn’t prioritize those types of enrollments, so they’re not going to cover the gap for you and give you an older effective date. So being proactive and having your application complete and correct is extra important, because you’re not compliant at this point to seeing Medicare patients until that’s resolved. With the new Medicare enrollment same thing; you’re not eligible to start seeing your Medicare patients until your application is in motion and it’s, you know, going through processing to approval. So all the more reason to just be proactive. Pay close attention, and then, really, the sum of it is as a reminder, this is the open enrollment period. So if you want to make a change, definitely now’s your time.
Marc:
Yeah. And full disclosure, Rapid Credentialing is a corporate club member of the Illinois Chiropractic Society, so they do support your state association. But more importantly, the feedback that we get from our members has been all positive about Rapid. So, if you run into those roadblocks and you’re unable to get it taken care of your yourself through picos, if you’re making those changes, or if you run into a situation where you have to re enroll because you were disenrolled for not filing claims, and you run into those roadblocks and you need help, don’t hesitate to reach out to Rapid. Hopefully, this all helps you out, and we’ll catch you again next week.
