Request on behalf of Jill Gabbert, President of Goodcare AtHome Rehab:
A Medicare insurance type has the “This is a Medicare certification” under the plan dates that can be checked which then alerts the therapist when they need to do a recertification. And alerts the KX modifier, all good.
But…A Medicare replacement insurance type, does not have the box to check that it is a Medicare certification under the plan dates, even though they are also required for med replacement plans. Subsequently, an alert is not given to keep therapists compliant with timing of recerts.
So, when we have a Medicare replacement plan (Aetna, Medica, Humana etc), we have been setting them to Medicare insurance type so we get the alert for the recert. BUT…..it also gives an alert that a KX is needed as it tracks the cap, when a Medicare replacement plan doesn’t need that. It’s a pain to have to delete the KX from those claims when the system should be set up for a med replacement plan to have the exact same requirements as Medicare.
This is a Medica (Medicare replacement insurance type) client when trying to do a recert. I can adjust the dates, but there is no box to check indicating this is a recertification. Therefore, there is not an alert to tell therapists their recert is due.
This is a Medicare insurance type client. The highlighted is what we need for medicare replacement insurance types too since it is the same requirement as Medicare.
