Use These Tools to Check Eligibility
Question: We regularly see new patients, many of whom are Medicare beneficiaries. I know beneficiaries are entitled to certain services, especially preventive services — and that Medicare reimburses some of these services depending on timing. Is there a way to check whether a Medicare beneficiary has received a certain service before (or recently) before providing it? Florida Subscriber Answer: The Centers for Medicare & Medicaid Services (CMS) offers several resources for providers to check a beneficiary’s eligibility. There’s a Medicare Learning Network (MLN) reference document for Checking Medicare Eligibility, including the types of information you may receive as a response. CMS also offers a quick reference chart with some common services, so providers can check the frequency limits, access the relevant procedure and diagnosis codes, and see the criteria for Medicare coverage. Don’t forget you can always check with your respective Medicare Administrative Contractor (MAC) for specific information like local coverage determinations (LCDs). Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
