Medicare Compliance & Reimbursement

There are annual updates to Medicare coverage for beneficiaries, and it’s critical that your staff review information early in the calendar year to avoid denials later on, one Medicare Administrative Contractor (MAC) advises.

Background: Providers must review any coverage changes that the beneficiary has made for the new year and get a copy of the updated Medicare card on file, reminds Part B MAC Palmetto GBA in an alert.

For example, “if a patient has a Medicare Advantage Plan or is a Railroad Medicare beneficiary, you must file the Medicare claim to the correct insurer. Use the information on a patient’s Medicare Advantage Plan card to identify the insurer and direct claims and questions to that plan,” Palmetto GBA adds.

“Failure to submit claims to the correct insurer delays payment and creates additional workload for providers and Medicare Administrative Contractors,” the Part B MAC warns.

RRB Reminder: All beneficiaries are assigned Medicare Beneficiary Identifier (MBI) numbers, including Railroad Medicare patients, and those numbers are no different from any other MBI. However, staff must be alert that Medicare cards issued to Railroad Medicare beneficiaries are unique and come with a “Railroad Retirement Board” logo and banner, Palmetto GBA indicates. This is important to remember because these patients’ claims are sent to the Railroad Specialty Medicare Administrative Contractor (RRB SMAC) versus the traditional MAC.

Tip: If a patient’s MBI doesn’t register in the system, all MAC jurisdictions have online portals where providers can crosscheck patients’ numbers and see if updates have occurred or are necessary.