How can a provider check Medicare eligibility?
In the healthcare industry, it is crucial for providers to ensure that their patients are eligible for Medicare benefits before rendering services. Medicare is a federal health insurance program in the United States that provides coverage for individuals aged 65 and older, as well as certain younger individuals with disabilities. Checking Medicare eligibility is essential to avoid billing errors and ensure that patients receive the appropriate coverage. Here’s a comprehensive guide on how providers can check Medicare eligibility effectively.
1. Utilize the Medicare Beneficiary Identifier (MBI)
The first step in checking Medicare eligibility is to obtain the patient’s Medicare Beneficiary Identifier (MBI), which replaced the Health Insurance Claim Number (HICN). The MBI is a unique, randomly generated 11-character number that helps protect the patient’s identity. Providers can request the MBI from the patient or verify it using the Medicare.gov website or the Medicare.gov app.
2. Access the Medicare eligibility verification tool
Medicare offers an online eligibility verification tool called the Medicare Coverage Database (MCD). Providers can access this tool by visiting the Medicare.gov website and logging in with their Medicare provider number. The MCD allows providers to check the eligibility of Medicare beneficiaries in real-time, providing details such as coverage status, deductible amounts, and plan details.
3. Contact the Medicare Administrative Contractor (MAC)
If a provider needs to verify Medicare eligibility for a patient with a pending application or for any other reason, they can contact the Medicare Administrative Contractor (MAC) responsible for their region. MACs are private companies that work under contract with Medicare to process claims and perform other services. Providers can find their MAC’s contact information on the Centers for Medicare & Medicaid Services (CMS) website.
4. Use a clearinghouse or billing service
Many providers use clearinghouses or billing services to process their claims and verify Medicare eligibility. These services typically have access to the Medicare Coverage Database and can provide real-time eligibility information. Providers can enroll with a clearinghouse or billing service and use their platform to check eligibility for their patients.
5. Stay updated on Medicare rules and regulations
Medicare eligibility rules and regulations can change over time, so it’s important for providers to stay informed. The CMS website provides the latest information on Medicare eligibility, billing, and coding requirements. Additionally, providers can attend workshops, webinars, and training sessions to keep up with the latest developments in the healthcare industry.
In conclusion, checking Medicare eligibility is a crucial step for providers to ensure accurate billing and proper patient care. By utilizing the MBI, accessing the Medicare Coverage Database, contacting MACs, using clearinghouses or billing services, and staying updated on Medicare rules and regulations, providers can effectively verify Medicare eligibility and provide the best possible care for their patients.
