What are the rules for scope of appointment for Medicare?
Asked by: Rachael Harvey | Last update: October 4, 2025Score: 4.2/5 (12 votes)
What are the rules for scope of appointment for Medicare 2024?
CMS 2024 Final Rule: 48-hour window
The 48-hour SOA rule has returned. The guidelines require a minimum 48-hour window between a Scope of Appointment form being completed and an appointment taking place with exceptions for beneficiary initiated walk-ins and the end of a valid enrollment period.
What are the requirements for CMS scope of appointment?
A completed Scope of Appointment should be submitted to the carrier with each MAPD or PDP enrollment application. This includes all applications keyed in electronically or submitted through any electronic means. CMS requires agents to keep the SOA for the current year plus 10 years.
What is the 48 hour rule for Medicare scope of appointment?
When do Medicare agents need to collect a Scope of Appointment form from a beneficiary? Per the CMS Final Rule 2024 (opens in a new window), all Scope of Appointment forms must be gathered at least 48 hours before the appointment — and this time limit should be taken literally.
What is the scope of appointment rules for 2025?
Medicare scope of appointment rules. The Medicare SOA rules 2025 are put in place by CMS. The SOA (scope of appointment) is a form clients/potential clients as well as agents must complete before meeting to discuss Medicare plans. The SOA is mandatory when discussing either Medicare Advantage or PDP plans.
Medicare Part D: FAQs, how Part D works
What are the new Medicare rules for 2025?
Medicare is a federal health insurance program for older adults ages 65 and older. Open enrollment for 2025 Medicare plans runs through December 7. Some major changes in 2025 include a new $2,000 out-of-pocket max under Part D, eliminating the plan's “donut hole” coverage gap, and fewer Medicare Advantage plans.
How long must you keep a scope of appointment?
How should the form be retained? Whether an application is taken or not, Medicare requires that you retain a copy of the Scope of Appointment form for 10 years and make it available to Medicare or the plan upon request.
What is the 2 2 2 rule in Medicare?
Introduced in the Fiscal Year 2014 Inpatient Prospective Payment System (IPPS) Final Rule, the two-midnight rule specifies that Medicare will pay for inpatient hospital admissions when a physician reasonably expects the patient's care to require a stay that crosses two midnights, and the medical record supports this ...
In which of these situations must a scope of appointment form be collected at least 48 hours prior to the interaction between the agent and the beneficiary?
If a sales agent is approached by a beneficiary at a sales/marketing event and the beneficiary indicates that they want to be enrolled into a plan, the agent must collect a valid SOA and can schedule a personal sales/marketing appointment to occur at least 48 hours after obtaining the SOA.
What is the 7 minute rule for Medicare?
Enter the 8-Minute Rule
If eight or more minutes are left over, you can bill for one more unit; if seven or fewer minutes remain, you cannot bill an additional unit.
What are the three types of SNP plans?
- Chronic Condition SNP (C-SNP)
- Dual Eligible SNP (D-SNP)
- Institutional SNP (I-SNP)
How long will CMS allow telehealth?
Telehealth services can be provided by all eligible Medicare providers through March 31, 2025. Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as Medicare distant site providers for non-behavioral/mental telehealth services through March 31, 2025.
Which of these is a prohibited statement in Medicare?
During the meeting, Medicare plans and people who work with Medicare can't: Charge you a fee to process your enrollment into a plan. Steer you into a particular plan. Communicate incorrect information about their plan type or use inappropriate statements like their plan is "the best" or "highest ranked."
What is the CMS rule for 2024?
Beginning January 1, 2024, CMS is finalizing implementation of a separate add-on payment for healthcare common procedure coding system (HCPCS) code G2211. This add-on code will better recognize the resource costs associated with evaluation and management visits for primary care and longitudinal care.
What is scope of appointment in Medicare?
Summary: The Medicare Scope of Appointment is a mandatory form that beneficiaries and potential beneficiaries must sign before meeting with an insurance agent to discuss Medicare Advantage options. Also known as the Medicare 48-Hour Rule, it's in place to protect you from high-pressure situations and scams.
When must the scope of appointment be obtained from the consumer?
The scope of appointment must be obtained from the consumer before the start of a marketing appointment. This is a necessary step to ensure that the consumer is fully aware of the topics that will be discussed during the meeting, whether it's in-person or telephonic.
What is the 48-hour rule for scope of appointment?
As a general rule, agents should not arrive at a beneficiary's home to conduct a presentation without a Scope of Appointment having been captured at least 48 hours in advance.
Which of the following settings is a scope of appointment form not required to be collected?
An unscheduled meeting with a beneficiary who arrives at an agent's office without an appointment and requests information is the only scenario listed in which a Scope of Appointment form is NOT required to be collected.
How to fill out a scope of appointment?
- The beneficiary's name and contact information.
- The date of the appointment.
- The agent's or broker's name and contact information.
- A list of the specific topics or products the agents can cover during the appointment.
What is the Medicare 3 day rule?
Pursuant to Section 1861(i) of the Act, beneficiaries must have a prior inpatient hospital stay of no fewer than three consecutive days to be eligible for Medicare coverage of inpatient SNF care. This requirement is referred to as the SNF 3-Day Rule.
What is the new rule for Medicare?
Beginning in 2025, the Inflation Reduction Act of 2022 requires all Medicare Prescription Drug Plans (Part D plans)—including both stand-alone Medicare prescription drug plans and MA plans with prescription drug coverage—to offer Part D enrollees the option to pay out-of-pocket prescription drug costs in the form of ...
What is the Medicare 85% rule?
Medicare pays for medical and surgical services provided by PAs at 85 percent of the physician fee schedule. This rate applies to all practice settings, including hospitals (inpatient, outpatient and emergency departments), nursing facilities, homes, offices and clinics. It also applies to first assisting at surgery.
Can you do a verbal scope of appointment?
What Is the Scope of Appointment (SOA)? The SOA is an agreement you sign before discussing specific Medicare plan options with an agent. For telephonic sales, agents will read the agreement to you and ask for verbal consent. In-person or virtual meetings may require you to complete the form on paper or electronically.
Which of the following statements about the scope of appointment is false?
Final answer: The false statement about the Scope of Appointment (SOA) is that it is required by law for all insurance sales appointments. The SOA is specific to Medicare sales and serves to restrict discussion topics and protect beneficiaries from unsolicited sales practices.
What are the enrollment periods for DSNP?
Dual Special Needs plans (D-SNPs) have an ongoing Special Enrollment Period (SEP), which runs for the first 9 months of the year. People who qualify can enroll or change plans once every 3 months. Enrollment changes will be effective the first day of the next month.