How to check Medicare status quickly and easily

For physician practices, hospitals and all healthcare organizations, streamlining your revenue cycle management is critical. One of the best ways to recoup payments faster is with up-front Medicare eligibility checks. With the changes in the Affordable Care Act, patient responsibility is often in play and healthcare organizations who can communicate effectively with patients about how to pay for their medical treatment will be more successful at collecting full payments.

Why checking Medicare status is important

Medical benefits are always changing so it’s important to check the Medicare status of your patients often whether it’s for prescription drugs or a specific procedure. This can cause a strain on some physician practices, care facilities, hospitals and other healthcare organizations. Save staff time and resources and quickly determine Medicare status with ABILITY CHOICE^® Medicare Eligibility. With 24/7 access to Medicare’s HETS database, your staff will be able to gather real-time, detailed eligibility status and medical benefit information, allowing you to:

• Receive payments faster by verifying Medicare eligibility at the beginning of patient care
• Reduce staff workload
• Quickly identify Medicare replacement plans and secondary payers
• Reduce denied claims with upfront identification of Medicare supplement or Medicare Advantage plans

How often should you check Medicare eligibility?

It’s important to check your patient’s Medicare eligibility throughout their course of treatment. Working with an information technology company can help reduce the time spent completing these frequent Medicare status checks. At the very minimum, you should check Medicare status:

• The first time the patient reaches out to you for medical service
• Before any submission of a home health request for anticipated payment (RAP)
• Before any submission of a hospice notice of election (NOE)
• Before every claim submission

What information do you need to check Medicare status?

To check Medicare eligibility, you must have the following patient information:

• First and last name
• Medicare Beneficiary Identification number (MBI)
• Date of birth (month, day, 4-digit year)
• Gender

What can you communicate to patients with a Medicare eligibility check?

Communicating often and effectively with patients is key to receiving complete payment for medical services in a timely manner. Being able to check Medicare status quickly and often will allow you to know and communicate to patients:

• The deductible amount they have remaining for the year
• Information about their primary insurance if Medicare is the secondary payer
• Any patient-enrolled Managed Care Organization (MCO) or Health Maintenance Organization (HMO)
• That status checking is 100% HIPAA compliant

Let Inovalon help with your Medicare eligibility checks

No matter the size your practice or healthcare organization, Inovalon can help simplify complex revenue cycle management processes with the latest data-driven applications. You can count on us to optimize reimbursements and the quality of care you offer.

Request a demo today. We look forward to helping your organization grow!

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