‘Tis the season for gift giving, and I want to pass along a professional gift you can give to your future self.

It’s the gift of knowing which of your patients are switching to, from, and between Medicare and Medicare Advantage Plans (MAPs) – and the name of their new plan – in advance of the switch!

Next Episode: Thursday, June 20, 2024

Using the Medicare Portals

As I am sure you know, DME suppliers can check eligibility using search tools available on the myCGS and Noridian Medicare portals using the Medicare Beneficiary Identifier (MBI).

Many suppliers don’t know, however, that those searches return future effective dates and the name of the beneficiary’s new plan. Queries capture beneficiaries moving to or between Medicare Advantage Plans, as well as those transitioning back to Medicare FFS from MAPs.

Some MAPs host eligibility tools on their own sites, but those rarely capture future termination dates or the name of the plan where the beneficiary is moving away from the current host. As such, we recommend sticking with Medicare’s comprehensive database.

Batch Eligibility Tools Embedded in Billing Software

Though very powerful, suppliers must query each beneficiary separately when using the DME MAC portals. Fortunately, many billing applications include features that enable batched searches of Medicare’s eligibility database.

Billing applications typically perform automated eligibility checks for all beneficiaries with active orders on a predetermined schedule … usually nightly or monthly. We recommend you confirm with your software vendor that their tools capture future effective dates.

Suppliers Don’t Have to Wait for January Denials

Medicare’s open enrollment period ends December 7. That means substantially all the 2024 changes will be locked in by the end of this week. Savvy suppliers that research between now and the end of the year can secure medical documentation and initiate any future authorizations required by the new plan before January claims bill to an old plan and deny.

It’s a gift that keeps on giving!