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Medicare screening test denials
REMINDERS FOR PATIENT SCREENING
Quarterly data analysis identifies three top denials/rejections that could be significantly reduced or eliminated by providers who have an effective patient screening process in place.
The three patient screening-related billing errors identified are:
MA plan denials.
Beneficiary eligibility denials.
The following are suggestions to increase your existing patient screening office procedures:
Verify the patient’s name and Medicare number to his Medicare card. The name used on all documents should match the Medicare card exactly.
The patient’s name and Medicare number should match the claim that is submitted to Medicare.
Patient eligibility can be obtained from the Medicare card. However, if the patient joins an MA plan or terminates Part B coverage, the patient may still continue to carry the Medicare card. Do not use the Medicare card as a guarantee of Medicare eligibility.
Periodically verify the patient’s insurance information to determine if any changes
have occurred. If changes have occurred, the patient's records should be updated accordingly. Collection and maintenance of up-to-date patient and insurance information is critical for offices in today’s insurance environment.
Verify a picture ID of the patient to ensure the Medicare beneficiary/recipient is not a victim of identity theft and the Medicare identification is not being used without knowledge or consent.
Failure to perform adequate patient screening and maintain up-to-date files can be viewed as a violation of the provider agreement with Medicare. Patients must be prompted to share other possible coverage that may be primary to Medicare.
Use the IVR or the online inquiry system to verify the patient’s Medicare eligibility, determine if Medicare is primary or secondary and identify those patients who have joined an MA plan that would replace “traditional” Medicare.
A few minutes of patient screening during each patient’s visit can save providers time and money later!
Something to think about: Fold the CMS-1500 claim form in half just below Item 12 and Item 13. The top half of the claim form is based on information that is obtained during patient screening. The bottom half of the claim lists what the physician provided for the patient and identifies the office information.
Performance of the patient screening tasks should be considered a job with great responsibility. The physician services will not be processed correctly if there is no patient screening process in place to ensure the claim is submitted correctly – the first time.
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