Insurance Verification for Medicare

Hospitals are working towards the benefit of people by making medical care available for every individual. It is, therefore, patients visiting hospitals with an insurance claim are always welcomed to get treatment from the best doctors. However, hospitals are required to make sure that the insurance claims made by so many individuals are true. It is false insurance claims are susceptible to denied claims and fraud. This is where insurance verification for Medicare comes in.

So, what is Medicare?

Medicare is an insurance program offered by the federal government. The program is for people belonging to the age group of 65 and onwards, people suffering from ESRD (end-stage renal disease) and certain younger people with disabilities.

The Medicare health insurance program is originally divided into two categories— Part A and Part B. Part D is the third category of Medicare that one may join for drug coverage. It is known as the Medicare Prescription Drug Plan (Part D).

The Medicare Part A plan is for hospital insurance covering inpatient hospital stays, nursing facilities, and some other health care benefits. On the other hand, the Medicare Part B plan is for medical insurance covering outpatient care, certain doctor’s services, preventive services, and medical supplies.

One may visit https://www.medicare.gov/ to get more information on application procedure, Medicare plans, eligibility, and costs, etc.

But how to avail insurance verification services for Medicare?

With the rising number of false insurance claims, hospitals are now opting to outsource medical insurance verification services for Medicare from medical billing companies. A prominent medical billing company ensures thorough verification of Medicare claims to help hospitals prevent denied claims and fraud. It is the responsibility of the verification specialist to cross-check the patient’s Medicare claim with the primary and secondary payer. The following steps are followed by the verification specialist for an error-free insurance verification for Medicare.

1. Patient Scheduling/Appointment
2. Patient Enrollment/Registration
3. Medicare Eligibility and Verification
4. Medicare Insurance Authorization
5. Contacting Patient
6. Updating Medical Billing System

The first two steps are important to keep track of a patient by gathering his/her demographic details and medical history. The third and fourth steps are essential to verify the Medicare claims by contacting the payer and getting it approved. The last two steps are important to maintain transparency by keeping the patient informed about any latest changes and keeping track of correct payment details.