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.
The Centers for Medicare and Medicaid Services requires that Priority Health providers offer services in a culturally competent manner to all members, including those with limited English proficiency or reading skills. This requirement is in your Priority Health Medicare contract.
The Office of Minority Health (OMH) offers information on providing culturally competent services on their website, www.thinkculturalhealth.hhs.gov. CMS has also developed an online Health Care Language Services Implementation Guide to help your office meet this important CMS standard.
As a contracted provider, knowing what Medicare covers and what supplemental services Priority Health Medicare Advantage plans cover is important. If you are unsure about coverage, contact us. We can help you and your patients with what is and is not covered.
Learn more about coverage from:
- The National Coverage Determinations Alphabetical Index
- MLN Matters newsletters from CMS
- WPS-Medicare, the Medicare Contract Administrator for the State of Michigan
- Priority Health Medicare Advantage Summary of Benefits and EOC documents on this website
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 Priority Health Medicare 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 provider account 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.
- NPI numbers
- Electronic funds transfer (EFT)
- Physician status
- Open or close to new patients
- Availability standards
- Changes to address or staff
- Provider-patient relationship
- Medical & office records
- Medicaid patient treatment
- Medicare patient treatment
- Site visits
- Fraud, waste & abuse
- Utilization Management Program