How to Verify Medicare Eligibility

Verifying Medicare eligibility is a common task in medical offices, hospitals and outpatient treatment centers. Each office must complete this task without violating the patient's privacy. Presenting a Medicare card at the time of the office visit does not necessarily prove the person's eligibility.

Things You'll Need

• Guidelines published by the Centers for Medicare and Medicaid Services
• Phone numbers or Internet access for Medicare verification companies

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Instructions

• 1

  Verify the identity of the person by checking her driver's license against the Medicare card. The names on both cards need to match.

• 2

  Check the age of the patient. Persons 65 or older are the primary recipients of Medicare. Special circumstances may allow the person to receive Medicare at an earlier age.

• 3

  After the patient has seen the doctor, the Medicare verification process may start. Medical care cannot be withheld while the verification process is under way.

• 4

  Call or go online to an Internet-based verification company for Medicare authorization of the office visit. Verification websites are convenient and can verify Medicare eligibility with a few keystrokes. They will tell you whether the patient should pay immediately for the office visit or whether you can bill for the fee. ESolutions and American Health Data Services are fee-for-services verification companies, and enrollment must be done before getting verification (see References).