Requirements for Treating Medicare patients

Providers who treat Medicare patients are required to comply with state and federal regulations related to patient rights.

Providers may not deny, limit, or condition the provision of services to Medicare members on the basis of:

• Claims experience
• Evidence of insurability (including conditions arising out of acts of domestic violence and disability)
• Genetic information
• Health status (end-stage renal disease excluded)
• Medical history
• Receipt of health care

Providers must comply with federal anti-discrimination law, including but not limited to:

• The Civil Rights Act
• The Americans with Disabilities Act
• The Age Discrimination Act

Also see the fraud, waste and abuse awareness training in this manual. Providers who care for Medicare patients are required to review this information annually.

Advance directives

Providers are expected to inform patients of their right to formulate advance directives, and document in a prominent place in the medical record if a patient has executed an advance directive.
Go to the Advance directive information on the prioritymedicare.com website.

Restrictions on marketing to Medicare patients

Priority Health has strict policies on how providers may market services to members of Priority Health Medicare plans. If you are interested in marketing to these patients, call your field service representative to assist you in identifying activities permitted by Priority Health.

Participating providers may market themselves and their services to Priority Health Medicare members only:

• As a participating provider of the network, and
• In coordination with Priority Health.

Marketing by a network provider will be regarded as marketing by Priority Health. All marketing materials describing Priority Health or its Medicare plans in any way must have the Priority Health logo as well as the provider/provider group name or logo. Also, materials must adhere to the Priority Health guidelines.