Medicare Advocate FAQs

As an Umbra Medicare advocate, you are partnering with Umbra to serve Medicare beneficiaries. Umbra conducts marketing to attract Medicare clients and we use our Supervising Providers to qualify they are eligible (a requirement by CMS) for Medicare-covered services. We then match these clients to advocates to complete the advocacy work.

In this model, you still do the advocacy work but it is under the supervision of a Supervising Provider. In addition, there are more structured requirements for developing care plans and documenting your work and time spent. 

If you have clients of your own that want to use Medicare to pay for your services, you can also bring them to the Umbra platform. Our team will qualify them for Medicare-covered services and you can be their advocate. We also handle all the billing for you.

Umbra will handle all of the patient billing. All Advocates and Supervising Providers must provide clear, accurate and complete documentation. We have built our systems with simplicity and efficiency in mind to make this as seamless as possible for you. 

Advocates will log time entries within one day of delivering services. 

By the 5th of the month, advocates will submit an invoice to Umbra for the prior month's services. Umbra  will process payment for the prior month’s approved timesheets within 30 days.

Timesheet and invoice formats and manner will be specified by Umbra, to include dates of service, patient identifiers, start and end times, and brief activity descriptions.

All work you do with the patient, or on behalf of fulfilling the patient’s needs, as it relates to what is covered under PIN and CHI services can be billed for, provided there is clear documentation and the service is legitimate. 

Activities like non-patient admin work, travel, general education and training and non-patient related emails would not be billable.

We understand that CMS rates do not match most private-pay rates, and do not meet many advocates’ needs or expectations. We recognize that this offering is not for everyone. 

There are advocates for whom Medicare reimbursement represents an opportunity to get paid for otherwise pro bono cases, to fill gaps in their schedule, or to have access to clients they do not personally have to find and engage. It is important to us that we provide opportunities for advocates with these perspectives. 

There are also other roles for licensed MDs, NPs and PAs, like conducting initiating visits and assessments to determine patient eligibility for PIN/CHI services and serving as the Supervising Provider to oversee ongoing services, when patients are deemed eligible. 

If you hold an active license in one of those categories, and might be interested in serving in that capacity, we are happy to tell you more about it.

Payment will be made from Umbra to you as a 1099 contractor. As you are an independent contractor in this arrangement, we will not withhold social security or taxes. 

Specific codes will vary based on the services provided and the CMS rules that apply. The following table shows the set of codes we will most likely draw from.

For PIN services, beneficiaries must meet the following criteria:

• Patient must have 1 serious, high-risk condition that is expected to last at least 3 months and that places the patient at significant risk of 
  • Hospitalization
  • Nursing home placement
  • Acute exacerbation or decompensation
  • Functional decline or death
• For the codes specific to peer support, the criteria includes 1 serious, high-risk behavioral health condition that is expected to last at least 3 months and places the patient at significant risk of hospitalization, etc. (list above)
• A condition that requires development, monitoring, or revision of a disease-specific care plan and may require adjustment in the medication or treatment regimen, or substantial assistance from a caregiver
• Billing provider must initiate PIN services during an initiating visit to address a serious, high-risk health condition

For CHI services, beneficiaries must meet the following criteria:

• Billing Provider must identify that the patient has unmet Social Determinants of Health (SDOH) needs that significantly limit the provider’s ability to diagnose or treat the patient.
• Billing Provider must conduct an initiating visit and an assessment to determine beneficiary eligibility.
• Patient must consent to receiving CHI services.

A Supervising Provider is responsible for overseeing the patient’s care and ensuring compliance with CMS standards. The Supervising Provider conducts an initiating visit and determines a patient’s eligibility for PIN or CHI services. If the patient is eligible, the Supervising Provider conducts “General Supervision” for the services. “General Supervision” means providing overall direction and control, periodically reviewing documentation and confirming that billed activities match the patient’s needs and CMS requirements, and reviewing and adjusting care plans, as needed. Provider presence is not required during the performance of the Services.

An Advocate, on the other hand, provides PIN or CHI services, assisting the patient with navigating healthcare services and creating an action plan. While Advocates can provide direct support, Supervising Providers conduct oversight and the services are billed under their NPI.

These services will typically be provided virtually.