Medicare Confusion Can Harm Your Health Care Practice

For many people, Medicare is like home owner's insurance. They have it, but they don't know much about it. As a result, they don't always get the type of coverage that's best for them. If you're a health care provider with patients on or about to get Medicare, that can translate into an erosion of your patient base and even a loss of income due to claims denials. There are ways to prevent this though, and now is the best time of the year to do it.

In February 2006 the California HealthCare Foundation released results of a study that clearly demonstrated that 64-year-olds who are about to get Medicare know very little about the Medicare coverage they will have for the rest of their lives. As someone who has worked in the Medicare field for 15 years, I can confidently say that the same is true for most people who already have Medicare. Many people don't know what their coverage options are for getting Medicare benefits and don't know how to get information about Medicare, yet they would like more guidance so they can make the right decisions for their situation. With the first wave of the estimated over 77 million baby boomers about to get Medicare, and over 44 people already on Medicare, there's no question that there's a captive audience for Medicare information.

What can happen if they don't know about Medicare?

A patient's lack of Medicare knowledge can have a decidedly negative impact on your health care practice. For example, when a patient is unaware of his coverage, he may inadvertently enroll in a Medicare plan that results in your having to end your relationship with the patient because you don't participate in the plan. Another patient may enroll in a Medicare plan but mistakenly provide her Original Medicare insurance card to the desk staff, resulting in your providing non-covered care and potentially having to absorb the cost of the denied claim. Another patient may join a new Medicare plan without realizing that the new plan doesn't cover his regular dentist visits. Yet another patient may join a Medicare Prescription Drug Plan without realizing that the drug you've prescribed him for years is not covered by that plan, and the patient may lose trust in you when he gets the false impression that you made a mistake when you prescribed a different (covered) drug. Situations like these can easily erode patient base, fracture the provider-patient relationship, and possibly even cause you to lose money.

What do they need to know?

There is one way to help prevent this all from happening, and that is through written communications coming from you, the health care provider. The possibilities for what to say in those written communications are numerous. To refrain from overwhelming your patients and to ensure that any communications specifically aim to reduce potential Medicare insurance problems related to your office, focus your communications on a few messages that directly affect your office. For example, the materials may define the different types of Medicare health plans, list those you participate in, and explain how each plan you participate in works (e.g., whether the patient will need to get a referral to see you or not, whether they'll need to file claims, etc.). The materials could address Medicare prescription drug coverage and what steps the patient should take when choosing a plan to ensure they can keep taking the drug you prescribe to them. They could explain what Medicare Part B is and whether the patient should get it (this would help ensure coverage of services you provide). Or, they could inform people about how to choose plans (this might be especially important in a dental or chiropractic office, where patients need to know how to determine if a plan covers dental or chiropractic care).

How do you tell them?

In the California HealthCare Foundation study, respondents provided answers to how they wanted to get information about Medicare. Their responses were not unlike what I've heard from people with Medicare in the past. They said that they wanted anything that explains Medicare to be in plain, simple language from someone who is clearly not trying to sell them something. English-speaking respondents said they wanted information in printed form and in the mail. They said they wanted to be able to re-read the information and to write notes on it. While they were not against having information on the Internet, they said that they would still want a postcard in the mail letting them know about the website, so that they wouldn't have to search for it.

It's clear that people want information about Medicare, but they don't want to have to work hard to get it. From the standpoint of the health care provider, it's not too hard to respond to this desire. Fact sheets, newsletters, or brochures on Medicare are easy to place strategically in the waiting room. They can be included in an envelope when sending letters to patients. They can be placed in patient care rooms. The possibilities are numerous.

Now's the time to act

After you decide what Medicare information to provide to your patients and how to disseminate it, you need to decide when to give it out. It makes sense to provide information to your patients throughout the year, but the fall is by far the best and most important time of the year to give out Medicare information. Medicare's open enrollment season begins on November 15 and lasts through the end of December. Medicare health and prescription drug plans begin marketing their new plans in early October. To stay ahead of the communication curve, start creating your communications materials no later than September so that you can have them available by the middle or at the latest, the end, of October.
Informative, targeted communications could go a long way toward strengthening your office's relationship with both your Medicare patients and your patients who are about to get Medicare. In addition, with just a few materials written and printed professionally and made available in the fall, you could help secure your place in an ever increasing Medicare market.