Medicare Compliance & Reimbursement

Don't neglect middle names, or claim may be shunned.

Physicians in offices that doesn't always check Medicare beneficiaries' cards to verify the information, take note: Claims with bad names (or other incorrect personal info) may face denials.
 
Physicians are facing denial rates as high as 50 percent due to the new Medicare requirement to match patients' names and other identifiers to their Medicare cards, providers claimed in Medicare's June 7 Physician Open Door Forum.
 
Docs Better Find Out If It's 'Bobby' Or 'Robert'

In some cases, providers may have the patient's correct name, but the patient is enrolled in Medicare without a middle initial. Some online databases may provide incorrect information, stymieing providers who haven't had access to a patient's Medicare card directly.
 
Some patients may have registered with Medicare under a nickname, such as "Bobby," which they've used for decades. 
 
Officials with the Centers for Medicare and Medicaid Services say they're looking into the issue, but didn't make any promises. They claim they added the edit because providers were billing for services they actually provided to a different patient, or didn't provide at all.
 
In many cases, married patients or twins can have similar names as well as Medicare numbers that only differ in the final letter.
 
Physicians could face as much as a 30-percent cut in their Medicare reimbursements as a result of this edit, one provider told the forum. Untangling these errors could also cost physician practices a lot of money and force them to turn collection agencies loose on patients.