Many Medicare patients start the new year with new insurance plans. DME suppliers, often the last to find out about coverage changes, find themselves scrambling in January to catch up after getting denials from inactive plans. Fortunately, Medicare eligibility searches permit suppliers to identify plan switches in advance. The time between the end of Medicare’s open enrollment period (December 7) and the new plan’s effective date (January 1) provides a window for suppliers to properly prepare.
Suppliers should first compile a list of existing patients covered by Medicare, including those already enrolled in Medicare Advantage Plans (MAPs). During open enrollment, beneficiaries can switch between different MAPs, as well as to and from Medicare fee-for-service (FFS). Simple database queries or ad hoc reports from internal billing software are useful in compiling the list.
Next, suppliers should use automated batch eligibility tools within their billing software and clearinghouses to identify patients slated to start new coverage in 2022. Medicare eligibility responses include future data for the four months following each queried service date, so suppliers can easily identify plan changes in advance. Suppliers without batch tools can use myCGS and Noridian Medicare portals to individually investigate patients at risk for plan switching. For patients already in a MAP, suppliers need to search using the patient’s original Medicare MBI number.
For patients switching insurance, suppliers should complete the following before the end of the year:
Deductible season has its own cash flow challenges. A small December project to stay in sync with patients changing insurance will almost certainly make for a better start to the new year.
Suppliers should first compile a list of existing patients covered by Medicare, including those already enrolled in Medicare Advantage Plans (MAPs). During open enrollment, beneficiaries can switch between different MAPs, as well as to and from Medicare fee-for-service (FFS). Simple database queries or ad hoc reports from internal billing software are useful in compiling the list.
Next, suppliers should use automated batch eligibility tools within their billing software and clearinghouses to identify patients slated to start new coverage in 2022. Medicare eligibility responses include future data for the four months following each queried service date, so suppliers can easily identify plan changes in advance. Suppliers without batch tools can use myCGS and Noridian Medicare portals to individually investigate patients at risk for plan switching. For patients already in a MAP, suppliers need to search using the patient’s original Medicare MBI number.
For patients switching insurance, suppliers should complete the following before the end of the year:
- Assemble all documentation required for reimbursement under the new plan.
- Initiate prior authorization.
- Direct patients to schedule any physician office visits required by the new plan.
- Obtain a new proof of delivery ticket or prepare a written statement, signed by the beneficiary, attesting the supplier examined the equipment and confirms it meets Medicare requirements.
Deductible season has its own cash flow challenges. A small December project to stay in sync with patients changing insurance will almost certainly make for a better start to the new year.
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