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Medicare replacements

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PMRNC:

--- Quote ---Yes, Linda, this is what I meant.  For example United Healthcare was the replacement but in the patients demo's it stated Medicare and did not say UHC was the replacement causing it to be submitted without the AT modifier.  When I spoke to the provider she had the attitude as if I was supposed to know.  I asked " are there a lot of your patients with medicare replacements?" and  she says that there are a lot".  I was thinking you may want to let me know now what the medicare replacements are so that this does not happen again. 
--- End quote ---

Ok, just be SURE she means they are actual "replacements"like I said there is a difference.. You want to check that because really there shouldn't be A LOT. Replacements have not taken off the way CMS wanted. There are far more supplemental secondary to Medicare's than anything.  With that said, SOME of the patient's ID cards will say either Medicare Replacement, or Medicare Part C somewhere ON the card. I just came across one where on the BACK of the card it said "For benefit verification of Part C coverage call ----"  I wouldn't have known if I didn't look at the copy of the BACK of the card.   I do all my clients verifications, it's my own control thing that allows me to make sure these are all in order. My office managers in my clients offices do the "pre screening" It goes like this.   Receptionist or OM makes the appt, if it's a new patient, they have a pre-screening form they use to gather all of the information i need to verify benefits. That gets faxed to me and I verify benefits.   IT is very rare that I run into these problems from doing it this way, plus I don't have to worry about the staff missing something, it would be on me. Bottom line the only way to really prevent things like that is to be vigilant with verifications.

DMK:
And from a front office standpoint, many Medicare patients DON'T EVEN KNOW if their plan is a replacement plan.  That's what makes Medicare patient's so tough, they often can't keep track of the changes in their plans each year.

Linda is absolutely correct, someone needs to verify what kind of plan it is 1st thing.  That way you don't have to wait until Medicare tells you that you billed it to the wrong vendor.  I'm guilty of having this happen several times each year.  (Thanks for the Part C info Linda!)

QueenAlicia:
See, here is the thing, I DON'T authorize  benefits for them.  This is a fairly easy account really, they send the day sheets and their schedule and I submit claims, post payments, statements in their system.  Their OM verifies insurance and when it states medicare in the insurance column it does not state "replacement".  I don't even  see the insurance cards or anything.  So I started looking at the age of the patient to determine the use of the modifier so I know won't have the denials.

PMRNC:


--- Quote ---See, here is the thing, I DON'T authorize  benefits for them.  This is a fairly easy account really, they send the day sheets and their schedule and I submit claims, post payments, statements in their system.  Their OM verifies insurance and when it states medicare in the insurance column it does not state "replacement".  I don't even  see the insurance cards or anything.  So I started looking at the age of the patient to determine the use of the modifier so I know won't have the denials.
--- End quote ---

Do you mind if I ask are you billing them a %? If so it's to your benefit to take over this duty, if it's not or not included in your services your charging for, perhaps you can suggest adding it (at cost of course) and be sure they realize the importance of the task and how essential it is in the reimbursement process. they will be either TOO happy to let you do it OR get busy themselves and make sure they do it, Only one of those two are going to ensure proper reimbursement.

dekenn:
Just an FYI, at least with our Medicare contractor (Novitas), (and I would guess they all have it), there is a phone number that you can call that will tell you if they're Medicare eligible, and if so, if they have a different Medicare plan. You would have to know the doctor's NPI and PTAN though, to access the info, but it is an easy way to find out what they actually have.

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