VERIFICATION OF
INSURANCE INFORMATION
During patient registration, it is important for front office staff to identify
whether a beneficiary’s expenses should be covered by other insurance before,
or in addition to, Medicare. This information helps the office determine who to
bill and how to file claims with Medicare.
This is not an easy task. There are many insurance benefits a patient could
have and many combinations of insurance coverage to consider before determining
who pays and when. Depending on the type of additional insurance coverage a
patient has (if any), Medicare may be the primary payer for a patient’s claims
or be considered the secondary payer.
The office staff should:
* Copy the Medicare card and/or other insurance cards.
* Obtain essential patient information through use of completed medical
information/history and insurance forms.
* Determine Medicare eligibility.
* Determine “other” insurance coverage, claim submission guidelines and
limitations to coverage.
* Determine the proper order of claim submission, who is primary and who is
secondary payer. Obtain appropriate information to allow the claim to be
submitted to the appropriate insurance payer.
A good practice to incorporate into the patient screening process is to make
copies of the patient’s insurance card(s).
COPYING THE MEDICARE CARD
Verification is important since the information from the Medicare card should
be obtained during the patient’s initial visit. Medicare also recommends that
office personnel periodically verify a beneficiary’s insurance information to
determine if any changes have occurred. Rev. 9/2010 3 Patient
Registration/Screening
Pay close attention to:
*Exact patient name.
* Claim number.
* Type of insurance coverage.
* Effective date of coverage.
Claim rejections or denials could occur if complete information is not obtained
and supplied on the Medicare claim form submitted.
Mistakes in patient information can carry over to Medicare claims, causing
claim rejects, delays and even denials. These mistakes cause more work and can
be quite costly for an office.
Many offices also collect information such as health status and previous
condition/injury information, spouse and/or emergency contact information, and
information about the events surrounding the accident or condition. The
provider should also have the patient’s signature or the patient’s authorized
representative on file to authorize the release of any medical or other
information necessary to process claims submitted to Medicare.
Reminder: Item 12 or the electronic equivalent authorizes medical information
to be released and Item 13 or the electronic equivalent authorizes the claim to
be forwarded to a Medigap insurance plan.
Verification of correct patient information can also help protect providers
from potential Medicare fraud in cases where individuals are attempting to
falsely represent themselves as Medicare beneficiaries. Providers should always
ask their patients if they have changed their address or legal name since they
last visited their office. Many offices now ask for a valid photo ID when
registering a new or established patient or in cases where the identity of a
current patient is in question.
Something to consider with a Medicare patient: Just because the patient is
carrying a red, white and blue Medicare card does not guarantee that the
patient has Medicare Part B benefits. Under Medicare Part B, the patient must
pay a premium to have Part B entitlement. If the patient chooses to discontinue
the Part B Medicare coverage for whatever reason, they may still continue to
carry the Medicare card. It is extremely important to verify the patient’s
Medicare eligibility and never “assume” that possession of the card is proof of
Medicare eligibility.
No comments:
Post a Comment