Intake Suggestions
A good start for billing Medicare is to get the correct information upfront from each patient. In this section, we will suggest a number of ways for you to get all the information you need to bill Medicare.
As you probably well know, there are certain specific facts about the patient that Medicare requires before they will even accept a claim. Those items are listed below:
- Name
- Address
- Phone number
- Birth date
- Sex
- Medicare information, i.e. HICN and any group information
- Secondary insurance information (if there is any), including ID number, group number and whom the primary insured is (employee, spouse, etc.)
- Assignment of Benefits date (if you are billing assigned)
These items should be easy enough to obtain from the patient, especially if you have a standard form for new patients to fill out. In addition, there are other questions you should be sure to ask each patient in order to have the most up-to-date and accurate information about the patient. There are several categories that are involved and they are listed below:
1. Insurance information
Be sure to ask the patient for his/her Medicare card and other insurance cards so that you can make copies of them (front and back) to keep in your files. Do this every time you see the patient and this will keep your insurance records accurate. There are also questions that you may ask of the patient in order to find out what kind of insurance he/she has. HCFA has set forth a list of questions that will help you to determine whether Medicare is a primary or secondary payer and you should ask them of your patient. Medicare is secondary when a patient has a group health plan; to determine this, HCFA has suggested that you ask these questions:
Does the patient have any group health plan coverage based upon his/her current employment?
Does the patient have any group health plan coverage based upon his/her former employment?
How many employees including the patient, work for the employer from whom the patient has health insurance?
Does the patient have any group health plan coverage based upon his/her spouse's or another family member's current employment?
Does the patient have any group health plan coverage based upon his/her spouse's or another family member's former employment?
How many employees including the patient's spouse or other family member's, work for the employer from whom the patient has health insurance?
Is the patient receiving black lung benefits?
Is the patient receiving workers' compensation benefits?
Is the patient receiving treatment for an injury or illness for which another party could be held liable or is covered under automobile no-fault insurance?
2. Information about other equipment
In order to avoid Medicare denials for same or similar equipment, it is important to question the patient about the equipment that he/she has or has previously had. Make sure that you ask the patient about whether he/she is currently renting equipment from another provider, or if they have purchased something similar in the last five years. If you find that he/she does have similar equipment from another provider, you may use an ABN to hold the patient responsible for the item.
3.Social Security information
To make sure that you are billing the correct DMERC for the patient's claims, be sure to ask him/her if his address is correct with the Social Security Administration. If the patient has moved, he/she must report his/her new address to the SSA.
By asking these simple questions before you even bill the claim, you can avoid potential problems in the future. The more information you have on a patient, the easier it will be to get your claims paid!
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