Provider Checklist Before Treating a Medicare Advantage Patient

Medicare is a government-funded program that helps to provide medical and hospital insurance benefits for persons over age 65 or those with disabilities. Medicare has different managed care plans for individuals to choose from. Medicare Advantage for example is a Medicare drug plan that enrolls individuals with Medicare Part A and B and many times eliminates the need for other supplemental insurance. Providers who accept Medicare Advantage typically complete a screening or verification checklist before serving these patients.

Insurance Information

• Providers want to be able to submit accurate information to Medicare so that they receive payment. Before treatment they will verify the following insurance information with the patient: Medicare eligibility (Part A or B or both), effective and termination dates, deductible for Part B, if current deductible has been met and if Medicare is the primary or secondary insurance for the patient.

Patient Information

• Patient information is always important because it identifies the patient with Medicare and the provider. Essential patient information includes birth date and age of patient---is patient over 65 and employment status. For Medicare reporting purposes, providers need the patient's health insurance claim number, the first six letters of the patient's last name and first letter of the first name. The checklist also includes verifying whether the patient has end-stage renal disease and whether the patient had diagnostic testing paid for through Medicare Advantage or other Medicare insurance.

Spouse Information

• Providers also check the employment status of the spouse, if applicable, to verify if the spouse carries primary or secondary insurance on the patient. Verification of supplemental insurance helps providers to receive all claims owed to them, as sometime Medicare only reimburses claims as a last resort.