DETERMINE MEDICARE ELIGIBILITY
Determine and identify all of the medical insurance benefits that each patient has. Patients can be covered by a wide range of insurance plans, including Medicare.
Remember: Obtaining complete and accurate information from the patient is essential to ensuring the accuracy of the Medicare claim information and patient identity information on medical documents and records.
Reminder: The Interactive Voice Response (IVR) unit will allow providers to verify the patient’s Medicare eligibility.
In an effort to assist providers in obtaining complete and accurate patient eligibility information, the Provider Outreach and Education department created a form to ensure key elements are obtained during patient registration.
The top provider claim denials and claim rejections all include errors made during patient screening. This tool is not mandatory; however, it will be a valuable asset in the office when incorporated into the patient screening processes currently in place.
Often providers fail to identify changes in a patient’s insurance information and claim rejections or denials occur. Most information can be verified on the Interactive Voice Response (IVR), but there are some areas that must be obtained by office staff to ensure that claims are filed correctly the first time.
Also, this form will assist providers in making sure they have the needed provider information before making the call to the IVR as well as prompting office staff to verify key components that make up a “complete” patient eligibility profile for the office. The “fillable” fields simplify the process and can be printed after completion.
Offices will see immediate and positive results when incorporating this form into current patient screening processes. Taking those few extra minutes to complete the form will save office staff time and research and give them confidence that the submitted Medicare claims will be less likely to reject or deny due to eligibility issues.
A copy of the two-page checklist is included as an example of this valuable tool. Use of this tool by front office staff can increase office staff’s knowledge of patient eligibility in minutes!