Medicare Compliance & Reimbursement

If you outsource your billing to other companies or agencies, you must ensure that your business partners know the ins and outs of Medicare, warns one Part B Medicare Administrative Contractor (MAC).

Context: When verifying Medicare claims status and eligibility, providers, as well as the companies they employee to do their billing, are required to use the Interactive Voice Response (IVR) system or online tools from their specific MACs, according to Centers for Medicare & Medicaid Services (CMS) guidance.

In a recent alert, Palmetto GBA noted an uptick in billing companies' and outsourced agencies' failure to use either the IVR or the Part B MAC’s eservices tool. On top of that, “some of these individuals are not familiar with basic Medicare coverage or billing requirements and explanations and guidance must be repeated on every call,” Palmetto says.

Advice: The responsibility to educate vendors, offer them claims resources and tools, and connect them with “knowledgeable staff” lies with the provider, Palmetto reminds. “You can help us by making sure that you are providing your vendor with access to the Medicare remittance and appeal notices for services and claims they will be working on.”

Reminder: When you outsource your billing to a vendor, they become privy to Medicare beneficiaries’ protected health information (PHI) — and the HIPAA Rules. Ensure that they are following the rules as financial penalties for impermissible disclosures are on the provider, Palmetto also cautions.

Review the Palmetto alert at https://palmettogba.com/palmetto/jjb.nsf/DID/AS4LHG6636.