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.
The accuracy and verification of the Medicare card information is extremely
important because this information will be used on many claim forms and medical
documentation materials throughout the patient’s history with the provider’s
office.
