When Will I Get My Medical Card
If you receive a letter saying you are approved for Medicaid, the last two pages of this letter will have your Recipient Identification . This letter is your HFS Medical Card. Your HFS Medical Card has the RIN, name, and birth date for everyone enrolled in your family.
Keep the letter safe. It has important information.
When To Enroll In Medicare If I Am Receiving Disability Benefits
If you are under 65 and receiving certain disability benefits from Social Security or the Railroad Retirement Board, you will be automatically enrolled in Original Medicare, Part A and Part B, after 24 months of disability benefits. The exception to this is if you have end-stage renal disease . If you have ESRD and had a kidney transplant or need regular kidney dialysis, you can apply for Medicare. If you have amyotrophic lateral sclerosis , you will automatically be enrolled in Original Medicare in the same month that your disability benefits start
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Why Is Credentialing So Important
Credentialing is the healthcare industrys best way to protect patients. It is a way to ensure that patients receive high-quality care from physicians who have met state licensure and certification requirements.
But what about physicians that own their own practice? If you dont work for a hospital or another doctors practice, do you need to be credentialed?
If you want to accept health insurance from patients, the answer is yes.
Insurance companies will not pay claims unless the physician is already credentialed. Like hospitals and large healthcare groups, credentialing is also used by insurance companies. It is another way for insurance companies to make sure that they are paying legitimate, licensed physicians.
Credentialing is a requirement if you wish to bill through Medicare and Medicaid.
Through credentialing, health groups verify that you have completed your medical training. They do this by looking at your diplomas, licenses, and certifications.
They also look to see if you have any pending medical violations.
Physicians will have to undergo credentialing many times throughout their careers. It is common for hospitals and healthcare organizations to re-credential every two years.
Keep in mind, credentialing isnt just for physicians working in hospitals. Almost every healthcare facility, urgent care clinic, and long-term care facility requires credentialing.
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What Nurse Practitioners Need To Know About Credentialing
When I was offered my first job in the emergency department, I assumed the transition would be smooth. After all, I was no longer a new graduate so my certification, licensure, and DEA number were all in order and ready for action. All I had to do was look over my contract and sign on the dotted line. I didnt even bother to negotiate . But I was wrong.
ThriveAP Intern Stephanie Bauer has used her administrative healthcare know-how to give us some insight into what nurse practitioners need to know about the NP credentialing process. Take it away Stephanie
The Process of Getting Credentialed for Your Nurse Practitioner Job
What does it mean to be credentialed as a healthcare provider? What about being certified? While the names are similar, the two are not the same thing. Healthcare certification is defined as official approval to do something legally or professionally. This is what you get when you pass your boards, or nurse practitioner certification exam. Credentialing is a system used by various organizations and agencies to ensure that their healthcare practitioners meet all necessary requirements and are appropriately qualified. Credentials are very specific to the type of provider and specialty.
The credentialing process involves the verification of education, licensure, certification, and reference checks. In order for a nurse practitioner or physician assistant to be eligile to bill government agencies and insurance companies, they must be credentialed.
Can I Get Medicaid For My Children
Yes, if your income is not too high. Medicaid and The Children’s Health Insurance Program provide low cost coverage to millions of families with children. Income requirements vary by state. In all but two states, children who live in four-person households with incomes up to $52,400 qualify for either Medicaid or CHIP. Eighteen states and DC will cover children in families of four who earn even up to $78,600, although sometimes families at the higher eligibility levels may need to pay more for the coverage.
If you have a baby while you’re on Medicaid, your baby will automatically be enrolled in Medicaid for their first year.
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Medicaid Managed Care Providers
Medicaid uses managed care organizations that deliver Medicaid health care services to beneficiaries. These companies are contracted with state Medicaid agencies and receive payments from Medicaid for their services. Kaiser Family Foundation has a chart that shows Medicaid MCOs in 39 states, along with their parent firms. This information was current as of September 2018 but is subject to change.
The table only shows MCOs that provide comprehensive services to Medicaid beneficiaries. Prepaid Inpatient Health Plans , Programs of All-Inclusive Care for the Elderly and Prepaid Ambulatory Health Plans are not included here. To see which providers are available near you, it is best to check your state’s website. For example, the NJ Department of Human Services Division of Medical Assistance & Health Services has a page devoted to helping beneficiaries choose an MCO.
MCOs can provide coordinated Medicaid healthcare services, prescription drug benefits and other kinds of supports. It is important to choose an MCO that operates in the county where the beneficiary lives, though. There will be additional eligibility requirements as well, so be sure to read everything over carefully.
B: Investigate Alternate Pathways To Eligibility For Nursing Home Medicaid
Medically Needy MedicaidMedically Needy Medicaid is available in 36 states, and Washington D.C., and is for getting Medicaid benefits to people who spend a significant amount of their income on care costs, even if their monthly income is above the Medicaid income limit. Another way of describing Medically Needy Medicaid is to say that an applicant becomes eligible if the difference between their monthly cost of care and their monthly income is less than a specific amount set by the state.
For example, if the Medically Needy Income Limit in your state is $600, someone who makes $3,000 per month would need to spend more than $2,400 on medical expenses to be eligible for Nursing Home Medicaid despite earning more than the monthly income limit for Medicaid.
Miller Trusts or Qualified Income TrustsAnother option is Miller Trusts or Qualified Income Trusts , which can get complicated but would be described basically as special accounts for someone to deposit income that put them over the Medicaid limit. Money in the trust would not count toward eligibility and would only be accessible by the applicant for specific purposes. The trust is managed by someone who is not the Medicaid applicant and can be used to pay for medical expenses not covered by Medicaid. Not every state allows for Miller Trusts or QITs.
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Waiting Periods In Chip
Section 2102 of the Social Security Act requires states to include in their state plan a description of how the state ensures that CHIP coverage does not substitute for coverage under group health plans. Prior to January 1, 2014, 36 states elected to institute a period of uninsurance ranging from one month to 12 months to address this requirement.
Effective January 1, 2014, CHIP regulations at 42 CFR 457.805 provide that a waiting period imposed under the state plan cannot exceed 90 days. Section 457.805 of the regulations also requires states to adopt certain exemptions to any waiting period. States have the option to adopt additional exemptions. Regulations at 42 CFR 457.340 and 457.350 require states to implement processes ensuring a smooth and seamless transition to other insurance affordability programs for which children may be eligible during a waiting period.
As of April 2021, only 14 states had a waiting period. The 22 states that eliminated their waiting period protect against substitution of coverage by using various procedures to monitor for substitution, including use of survey data, and private insurance database checks. Fourteen states have elected to continue to have a waiting period. Of these, 11 have a 90 day waiting period, 1 state has a two month waiting period, and 2 states have a one month waiting period.
The following table provides a summary of state policies in this area prior to, and subsequent to January 1, 2014.
How To Apply For Medicaid
The best way to find out whether or not you’re eligible for Medicaid is to submit a Medicaid application. Here are two ways to apply for Medicaid:
- Through your local Medicaid office
Once you apply for Medicaid, depending on your specific circumstances, it can take up to several weeks to process the Medicaid application. You can generally speed up your Medicaid application review process by making sure you completely fill out your application and include all required paperwork. If you fail to do this, your review could take longer. Keep in mind that once you’re approved and enrolled, your eligibility will be reviewed every year.
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What Does Medicare Part B Cover
Part B provides coverage for a mixture of outpatient medical services. This includes coverage for preventive vaccines, cancer screenings, annual lab work, and much more.
It will cover preventive services in addition to specialist services. Part B even covers services for mental healthcare, durable medical equipment that your doctor finds medically necessary.
Also, Part B will cover some services you receive while in the hospital. This includes surgeries, diagnostic imaging, chemotherapy, and dialysis if you obtain drugs while at the hospital, it will also provide coverage for those.
Medical Credentialing: How It Works And What It Costs
Credentialing is a term for a process that consists of two parts, credentialing and privileging. Credentialing is the verification of competency, as demonstrated by education, training, licensing and work experience. Privileging is the granting of approval for a healthcare provider to perform certain procedures based on the demonstration of competency.
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Who Is Eligible For Medicaid
The rules about who can use Medicaid depend on the state you live in. Federal law requires that states cover certain population groups. States then have the option of expanding coverage to other groups or making the coverage more generous.
For instance, in some states, if you’re disabled, you can use Medicaid no matter how much money you make. In other states, if youâre disabled, you may not be eligible for Medicaid coverage if your income is above a certain level.
Your income is important when applying for Medicaid. States usually have a cut-off based on your income. If you’re below a certain level, you may qualify. Some categories of applicants, including the elderly, disabled, and children in foster care may also have to meet an asset limit, depending on their state.
You might be eligible even if you earn more. Even if your income and assets are above the cut-off level, you might still get Medicaid if your medical bills are high. You may be able to subtract those expenses from your income. This is called the spend-down process. After you subtract costs like hospital care and doctor visits, your income will be lower and may make you eligible for Medicaid.
You may be able to start using Medicaid. The Affordable Care Act is helping states make Medicaid available to more people.
The idea is to open up Medicaid to people who have low incomes and can’t afford insurance on their own but who made too much to qualify for Medicaid in the past.
How To Find Out Medicaid Application Status
There are close to 75 million people covered by Medicaid in the U.S., and this program is funded and administrated by states and the federal government. Once an application is complete, it can take a while to process applicants can easily check the status of Medicaid applications, though. It is also important to note that some states have expanded their Medicaid services recently, and Healthcare.gov has links that provide specific details on this.
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Eligibility And Asset Transfer Rules
In the past, to avoid exceeding Medicaid’s income limits, some families would transfer a patient’s assets into the names of other relatives, such as the children. The Deficit Reduction Act of 2005 made such maneuvers much harder to manage. Now, when you apply for Medicaid, there is a five-year lookback at all asset transfers. If Medicaid finds money was transferred within the past five years, a penalty period is imposed, delaying the onset of Medicaid coverage.
Medicaid calculates the penalty by dividing the amount transferred by what Medicaid determines is the average price of nursing home care in your state.
For example, suppose Medicaid determines your state’s average nursing home costs $6,000 per month, and you had transferred assets worth $120,000. You will not be eligible for Medicaid assistance until you pay the cost of the nursing home for 20 months . There is no limit to the number of months for which someone can be declared ineligible. The penalty period begins on the day the patient enters a nursing home.
Not all transfers are counted in the lookback period. Arrangements that are allowed include transfers to:
Medicaid programs are paid for out of both federal and state funds.
How Medical Credentialing Works
Medical credentialing is a market-driven process that seeks to maintain standards of quality in the medical community for the benefit of patients. The process involves direct contact with primary sources for the verification of a healthcare providers qualifications. The credentialing authority will contact the university where the provider received their degree in medicine, had their training, and did their residency, to confirm their credentials.
They will also contact certification boards and licensing agencies to verify licenses and specialty certificates. Hospitals and other employers can provide confirmation of work history. Credentialing is important for all new hires, but it is performed at regular intervals even after hiring to conform to the standards of regulatory and accrediting organizations, like The Joint Commission , The Centers for Medicare and Medicaid Services , and the National Committee for Quality Assurance .
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What Happens After I Register For Medicare Online
Once you have submitted your application, it will be reviewed by Medicare to ensure all the information is accurate and complete. You should double-check your contact information to make sure it is correct. This is important to ensure prompt delivery of your Identification Card, as well as in the event Medicare needs to contact you about your enrollment.
After your application is received and processed, a letter will be mailed to you with the decision. If you encounter any questions or problems during the process, you can always contact Social Security for assistance.
When Is My Initial Enrollment Period For Medicare Part D
You can enroll in a stand-alone Medicare prescription drug plan during your Initial Enrollment Period for Part D. You are eligible for prescription drug coverage if:
- You live in a service area covered by the health plan, and
- You have Medicare Part A AND/OR Medicare Part B.
Generally, your Initial Enrollment Period for Part D will occur at the same time as your Initial Enrollment Period for Medicare Part B .
Once you are eligible for Medicare Part D, you must either enroll in a Medicare prescription drug plan, Medicare Advantage Prescription Drug plan, or have creditable prescription drug coverage . Some people may choose to delay Medicare Part D enrollment if they already have creditable prescription drug coverage through an employer group plan.
However, if you do not sign up for prescription drug coverage when you are first eligible for Part D, you may have to pay a late-enrollment penalty for signing up later if you go without creditable prescription drug coverage for 63 or more consecutive days.
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Medicare Vs Medicaid Roles In Nursing Home Care
Medicare does cover nursing home careup to a point. If you are sent to a skilled nursing facility for care after a three-day inpatient hospital stay, Medicare will pay the full cost for the first 20 days. For the next 100 days, Medicare covers most of the charges, but patients must pay $185.50 per day unless they have a supplemental insurance policy. For day 101 and beyond, the patient pays all costs.
These rules apply to traditional Medicare. People on Medicare Advantage plans likely have different benefits
Some nursing homes wont accept Medicaid patients outright, but the law forbids them from throwing you out if you become dependent on Medicaid when you are in their care.
Sign Up With Priority Health
If youre approaching 65 and are looking into Medicare coverage options, consider choosing Priority Health.
Priority Health offers a variety of tools to help you choose the health that works best for you, including easy online guides explaining Medicare and an online tool that allows you to compare plans.
To enroll, you can call a Priority Health Medicare expert toll-free at 888.481.1348 from 8 a.m. 8 p.m. seven days a week, or go to prioritymedicare.com to complete and submit the form online.
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Documents Needed If You Sign Up In Person
- An original or certified copy of your birth certificate or other proof of birth
- Proof of United States citizenship or legal residency if not born in the U.S.
- Your Social Security card if you are already receiving benefits
- A copy of your most recent W-2 form and/or self-employment tax return
- U.S. military discharge papers if you served before 1968
- Health insurance information
